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ResourcesNick Fuller2018-07-24T10:00:18-04:00

FORMS & RESOURCES

NEW PATIENT FORMS

Please print these forms and bring them with you to your first office visit:

  • Patient Demographics
  • Patient Medical History
  • HIPAA Form
  • Authorization to Disclose Medical Information
  • New Patient Pain Medication Agreement
  • Office and Financial Policy (signature page only)
  • Notice of Privacy Practice (for your information)

PATIENT RECORDS RELEASE

  • Cement City Patient Records Release
  • Coldwater Patient Records Release
  • Hillsdale Patient Records Release
  • Litchfield Patient Records Release
  • Reading Patient Records Release

HELPFUL FORMS / DOCUMENTS

  • Asthma Action Plan
  • COPD Action Plan
  • Diabetes Action Plan
  • Epworth Sleepiness Scale
  • STOP BANG Questionnaire
  • Blood Pressure Log
  • Blood Sugar Log

HELPFUL LINKS

  • Sleep Apnea (UpToDate)
  • Asthma and Allergy (Asthma and Alergy Foundation of America)
  • Diabetes (American Diabetes Association)
  • COPD (American Lung Association)
  • Food Allergy Network
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