Practice Fusion, our EHR (Electronic Health Record) system will remind you of your appointment 1 week and, again at 1 day prior to your appointment. You will also receive a confirmation email from my scheduling staff after you schedule your appointment, which will include a reminder to complete all required paperwork PRIOR to your appointment. The forms are all available below.
We all despise onerous paperwork. However, federal healthcare laws now require many forms to be completed on your first visit with any healthcare provider and additional forms to be completed on all subsequent visits. There is nothing we can do to avoid having you complete these forms and we are not legally able to see you until they are completed.
Please download ALL required documents according to the instructions below. We have included all of the required forms on this page for your convenience, as well as in the email from my office. These forms can be printed and hand-written/typed or mailed via regular mail if you do not have the ability to complete them electronically.
Unfortunately, because of the federal regulations, these documents are not elective, even if they do not directly impact your orthopedic care at AZISKS. They are legal documents so please complete all aspects accurately and sign them. Thank you very much for your assistance and cooperation.
If you need to reach us regarding questions about these forms or to change your appointment, please visit CONTACTS page on this website and use the corresponding staff email (not secure) or enroll in the patient portal (you will receive an email invite for this after your first visit). Once you are enrolled, you can direct message any staff member directly and securely through the EHR system.
Please note that even if you completed forms at any other medical practice in the past or recently, these forms MUST be completed prior to evaluation and treatment at AZISKS. We prefer that you complete all of the forms electronically and submit them PRIOR to your appointment to avoid late fees. Failure to submit ALL forms prior to your appointment OR bring them completed to your appointment will result in a $25 charge if your appointment is delayed as a result of incomplete paperwork.
In order to complete these forms. you will need to click this link to download Adobe Reader DC: ADOBE READER DC . Be sure to download the correct version for your computer’s operating system. If given a choice of download, choose ADOBE READER DC, which will allow you to complete and sign documents electronically. Always save a copy of your documents to a folder on your desktop. After installing Adobe Reader DC, please follow these steps:
1. Click on the appropriate forms to complete (these .pdf forms may have been emailed to you by my staff, if you requested them at the time of booking your appointment)
A. NEW KNEE PATIENTS: Forms 1, 5-9
B. NEW SHOULDER PATIENTS: 1, 5-9, 12 and 13
C. MEDICARE: All new patient or followup patient forms PLUS form 4
D. FOLLOW-UP (< 1 yr since last visit): form 10, 11 for shoulder and 10 only for other problems
E. FOLLOW-UP (> 1 yr since last visit): form 6 and 9 for ALL PLUS 10, 11 for shoulders; form 10 for all others;
F. FOLLOW-UP (> 3 yrs since last visit): follow instructions for NEW PATIENTS
G. FMLA form: form 2
H. MEDICAL RECORDS RELEASE: from 3
FAX: You may print the forms (if you did not sign electronically, please sign by hand) and fax to 855-661-0505 directly to our EHR.
HAND CARRY: Sign and date forms and bring to your appointment.
6. Please read the notice below.
IF YOU CANNOT SIGN THE FORM ELECTRONICALLY, PLEASE DO NOT UPLOAD THEM, AS THEY MUST BE SIGNED. IF YOU DO NOT RETURN YOUR FORMS PRIOR TO YOUR APPOINTMENT, YOU WILL NEED TO ARRIVE A MINIMUM OF 30 MINUTES EARLY as we are not able to see you until all forms have been completed and signed. If forms are not submitted prior to your appointment, you may incur a late fee if completion of forms in the office delays your appointment. We thank you for assistance in helping us make your visit at AzISKS pleasant and efficient.
NEW PATIENT CLINICAL FORMS-ALL PATIENTS
OPTIONAL ADMINISTRATIVE FORMS
NEW PATIENT FINANCIAL AGREEMENTS/DISCLOSURES- ALL PATIENTS
5. *AZISKS Financial Policy-Patient Agreement
6. *ERISA AOB-DAR for Insurance Benefits Release
7. *Financial Disclosure to Patients
8. *HIPAA Release of Information
9. *Hippa Privacy Notice
10. *Insurance and Financial Form