病人形式

病人形式 for 下载ing and Printing

一般形式

Below are the generic forms that are frequently used at our practices. In order to save time at your first appointment, we highly encourage you to complete the relevant forms beforehand and bring them with you to your appointment. If you have any questions regarding our patient forms, 请随意。 全球网赌十大网站.

Adult Demographic/Registration Form

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Adult Health History Form

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Agreement of Financial Responsibility Form

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Authorization to Release 信息

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Checking In for Your Appointment from 首页

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Comprehensive Primary Care Plus (CPC+) 信息

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Consent for Prescribing Opioids to Minors Form

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Consent to Photograph Form

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COVID-19 Info Sheet - Arabic

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COVID-19 Info Sheet - English

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COVID-19 Info Sheet - French

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COVID-19 Info Sheet - Nepali

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COVID-19 Info Sheet - Somali

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COVID-19 Info Sheet - Spanish

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Designation of Another Person to Consent for Treatment Form

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HIPAA Notice of Privacy Practices

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Parent/Guardian Consent for COVID-19疫苗

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Pediatric Demographic/Registration Form

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Pediatric Dosing Chart

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Pediatric Health History Form

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Request for an Accounting of Disclosures of Protected Health 信息 (PHI)

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Request to Amend Protected Health 信息 (PHI) Form

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Request to Restrict Protected Health 信息 (PHI) Form

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STARK Notice - 患者信息

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视图ing Test Results on the 病人门户 and Healow App

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Advanced Directives Forms

视图

心脏测试

咖啡因的信息

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Echocardiogram (Echo) 信息

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Pharmacological Cardiolite 信息

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Stress Cardiolite 信息

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Stress Echo 信息

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Stress Test Only 信息

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糖尿病管理

Africa Road Location Map

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Bethel Reed Park Location Map

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糖尿病管理 - Healthy Eating Made Simple

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糖尿病管理 - What's My Plate All 关于 Infographic

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糖尿病管理 Tips and 信息

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Medicare Patient Packet

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OSU Insurance Patient Packet

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Other Insurance Patient Packet

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Taylor Station Location Map

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秋天预防

CDC STEADI Toolkit - 秋天预防 Checklist

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Exercise - Heel Toe Raises With Counter Support

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Exercise - Sit to Stand Using an Armchair

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Exercise - Standing Heel Raise With Support

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Exercise - Standing Tandem Balance With Counter Support

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物理治疗

平衡困难 & 瀑布

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Cervical (Neck or Neck & 肩膀)

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腰 & 坐骨神经痛

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下肢(臀部 & 腿)

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Upper Extremity (Shoulder, Upper Arm to Hand)

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Vestibular (Dizziness)

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放射学(成像)

CT腹部-骨盆

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CT脑-头

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CT Coronary Artery Calcium Screening (CACS)

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CT Enterography

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CT四肢

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CT的脖子

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CT Renal - Kidney Stone

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CT窦

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CT的脊柱

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DEXA Scan Preparation Sheet

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腹部超声,

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超声波-主动脉

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超声波-主动脉 Screening

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超声波-颈动脉

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Ultrasound - Knee (Popliteal)

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Ultrasound - Lower Abdominal

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Ultrasound - Lower Extremity Venous

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Ultrasound - Renal (Kidney)

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Ultrasound - Renal Artery

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超声波-阴囊

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Ultrasound - Stress Arterial

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超声波-甲状腺

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