Patient Forms | danielduggando

Patient Forms

Patients have higher satisfaction with their health care when they partner with their doctors in their health responsibilities. As your physician, I am the expert on medical care, but you are the expert on yourself. By partnering with me as your physician, you can help ensure an accurate diagnosis and appropriate treatment and work with me to choose the option that best fits your values and lifestyle. This also serves to make sure you are confident in carrying out the treatment you have chosen. When you are prepared for your visit, you will get the most out of it. Please set aside a few minutes to fully complete the appropriate forms by answering all questions in preparation of your appointment.

This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

We understand that your medical information is personal and we are committed to protecting this information. We create a record of the equipment, services, and financial information about you. We use this record to provide you with quality equipment and services, and to comply with the certain legal requirements. This Notice applies to all of our records pertaining to your care. This Notice will tell you about the ways in which we may use and disclose your medical information. We also describe your rights and certain obligations we have regarding the use and disclosure of your medical information. Privacy laws require that we ensure the following:

We must maintain the privacy of your medical and financial information;
We must provide you with this Notice, which explains our legal duties and privacy practices with respect to your protected health information; and,
We must follow the terms of the Notice currently in effect.

Patient Privacy Act (HIPPA)

1. HIPPA Brochure

Patient Information

The Patient History and Physical Form provides for sharing more detailed information about your heath and physical history.

The Patient Information and Insurance Form provides us with important demographic and insurance information to ensure proper care and billing.

2. New Patient Forms