NEW PATIENT FORMS

GET A HEAD START ON PAPERWORK AND FORMS WE NEED TO PROCESS YOUR CLAIMS AND PROVIDE THE BEST CARE.

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CLINIC FILES AND HANDOUTS

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CONSENT TO TREAT MINOR

FORM TO BRING PROVIDING AUTHORITY TO TREAT WHEN PARENTS ARE UNAVAILABLE.  THIS IS FOR ANYONE UNDER THE AGE OF 18 YEARS.

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RECORD TRANSFER

FORM TO REQUEST RECORD TRANSFER TO OR FROM OUR CLINIC.

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What to do after the freeze.

Diabetic Glucose Tracking, now to fine tune your diabetic care.

Diabetic Glucose Tracking, now to fine tune your diabetic care.

Medical Privacy Information from Health and Human Services.

For Lacerations, Surgeries, Wounds.

Handout provides information about services available at TFM and those that may require treatment or supplies from another facility.  

Use the Body Map form to record location of moles, mark areas of pain, or other areas of concern to discuss at your next visit.  

Explanation of common lab results.  

Disability forms for parking, decals, placards for handicap parking

An Advance Care Plan is a document that tells your doctor how you want to be treated if you are terminally ill or permanently unconscious. You can use a Living Will/Advance Care Plan to tell your doctor you want to avoid life-prolonging interventions such as cardiopulmonary resuscitation (CPR), kidney dialysis or breathing machines. You can use this form to tell your doctor you just want to be pain free and comfortable at the end of life. You may also add other special instructions or limitations in your form.    More Information here - link

A Medical Power of Attorney is a term used in the State’s law prior to 2004. In the new law this is referred to as an Appointment of Health Care Agent. An Appointment of Health Care Agent is another type of advance directive that allows you to name a person to make health care decisions for you if you are unable to make them for yourself

An individual, other than a patient’s agent or guardian, authorized under this part to make a health care decision for the patient.  May be designated by personally informing the supervising health care provider. May make decisions if patient lacks capacity and no agent or guardian has been appointed.  Must follow the best wishes of the patient or act in the best interest of the patient.  May not make decision to withhold or withdraw artificial nutrition or hydration.  

Health Care Surrogate presentation - powerpoint

Explanation of common lab results.  

Introduction: Basic information for newly diagnosed diabetes.  There is much more to learn but this is a place to start.  

What should I expect?   What are the goals?  

What is the treatment?   Is there a cure?

Diabetes Information

Dig a little deeper on how to fine tune your diet and your glucose control to reduce future risks. What are we looking for?  What are the complications and how do I avoid them?

You told me that my glucose / sugar was high.  What dietary information do I need to follow now?

     

Information

How to Interpret Bone Density / DEXA results.

I get most complaints about what to eat healthy for breakfast.  Try these.

Kegel exercises designed to reduce leaky bladders.

Updated information about Calcium and Vitamin D.

National Digestive Diseases Information Clearinghouse.

Information about cholesterol numbers.

Helpful information about coumadin / warfarin and vitamin K

Most insurance covers annual eye exams for Diabetes.  Be sure you stay up to date.  Here are some local suggestions.

Information about Fatty Liver disease and risks.

Information about IBS diet to limit certain sugars.   ( copy from University of Arizona)

Important dietary information

Heart burn and acid reflux.

Also visit www.celiac.org for information

Information on gout and dietary prevention.

CT of the heart for evaluation of plaque and heart disease.  

High Fiber Diet Handout.

FDA handout on disposing of medications safely.

Dietary changes that can help your cholesterol.

Dietary information to prevent painful bladder and cystitis.

Low iron levels, tips and information to increase iron in your diet.

Information about kidney stones and prevention.

Information about Mono - AKA the “kissing disease”.

Information on Migraines, triggers and  prevention.

If you are prone to motion sickness or going on a cruise

Information about this gene mutation related to depression

Substance Abuse and Mental Health Services Administration

Information about medication concerns with reflux drugs

Information on over the counter medications for common complaints

Better than just salt and water.  More soothing.

Insomnia is a complicated issue to manage.  Start with some simple tips called Sleep Hygiene to improve your sleep habits.

If you've been seen for Benign Positional Vertigo in the clinic we recommended some exercises to help.  Here is a video to demonstrate.

Internet Links

www.familydoctor.org - A web site operated by the American Academy of Family Physicians, a national medical organization representing more than 93,700 family physicians.  Health information for the whole family.

Family Doctor

Benefits Check Up - “Get all the benefits you deserve. Find and enroll in federal, state, local and private programs that help pay for prescription drugs, utility bills, meals, health care and other needs.”

Benefits Checkup

“RxHope is exactly what its name implies...a helping hand to people in need in obtaining critical medications that they would normally have trouble affording. We act as your advocate in making the patient assistance program journey easier and faster by supplying vital information and help.”

Information provided by Vyvanse

RxHope

Link to Healthspring Medicare Advantage plan.

This is the only Medicare plan that we are currently accepting.

Healthspring

Some basics and fine tuning to help.

Prostate Cancer Screening infographic.  Also link to Treatment, Research, Prevention, Statistics and more at cancer.gov

Over the counter options for leg swelling.