Resources

Registration & Forms

• • New Patient Packet
  • Patient Information
  • DFMC Telemedicine Consent
  • Patient Medical History

• Advanced Directive Notification
• Authorization To Designate Release Of Health Information
• Authorization For Release Of Records
• Authorization to Disclose Health Information
• HIPAA Privacy Policy Statement
• CA Advanced Health Care Directives
• Office Policies Signature Sheet
• Request or Refusal for Language Interpretive Services
• Office Policies for Our Valued Patients
• Payment Policy
• HMO Member Acknowledgement of Financial Responsibility
• Acknowledgement of Receipt
• Physician-Patient Arbitration Agreement, Patient’s Copy
• Physician-Patient Arbitration Agreement, Physician’s Copy

These forms require Adobe Acrobat Reader to view. If you do not have Adobe Reader already installed on your computer, click the Adobe logo above to download.

How to Make the Most of Your Visit with Your Medical Provider

• Always have the following information ready to provide to us when you come to the office or call the office:
  • Name (first, middle, last)
  • Date of Birth (month/day/year)
  • The phone number you would like to be contacted by
  • Most current insurance information
  • Most current address which you regularly receive your mail
• Reason for your visit
• If you are a new patient, please arrive 15 minutes before your appointment in order to fill out necessary paperwork.
• It is the responsibility of the patient to provide this office with any change of personal information, for example, change in your insurance, new mailing address, etc.
• Please have all your pertinent medical records transferred to our office before your first visit.
• If you are taking medication, or vitamin supplements, please let your medical provider know.
• Keep a record of your health concerns and specific symptoms.
• If you are going to be over 15 minutes late for your appointment, you will be rescheduled for another day to see your medical provider.
• Medical providers reserve the right to discharge a patient from this practice with a 30-day notice to patient.
• If you choose to transfer your medical care from this practice, for reasons other than medical insurance restrictions or moving out of this area, you will not have the right to return as a patient to this practice.
• If you have not seen a medical provider from this office within the last 3 months and need a controlled drug prescription you MUST make an appointment. No triplicate prescriptions will be given without seeing your medical provider.
• It is required that all your new patient paperwork is returned to us before your first visit. This will allow your doctor/provider to review your chart ahead fo time and spend more time discussing with you your health care needs.

What is a D.O. (Doctor of Osteopathic Medicine)?

Both DO’s and MD’s are trained in a similar fashion. Both are fully qualified physicians licensed to perform surgery and prescribe medicine in the United States. Both training programs include four years of medical school, one year internship, and 2-7 years of post-medical training in the doctor’s chosen specialty. For more information about DO’s please visit www.osteopathic.org.

What is a PA-C (Certified Physician Assistant)?

A physician assistant (PA) is a licensed and highly skilled healthcare professional, trained to provide patient evaluation, education and healthcare services. A PA is supervised by a licensed physician. PA’s must take a rigorous examination in order to become certified and licensed in each state. They are able to prescribe medications, make diagnoses and recommend treatments. For more information on PA’s please log on to www.aapa.org.

The following websites may be helpful to you:

• AARP
• Chariton Insurance
• Desert Care Network
• Desert Oasis Healthcare
• Eisenhower Heath
• LabCorp
• Loma Linda University Health
• Medicare
• Precision Dentistry
• Quest Diagnostics
• WebMD