| Carolina Orthopaedic Center Patient Forms |
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New Patient History
(.pdf - 1.4MB)
All new patients must complete this form. |
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Medical History
(.pdf - 184k)
All new patients must complete this form. |
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Complete Accident Details
(.pdf - 116k)
All new patients must complete this form. |
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HIPAA Notice of Privacy Policies and Practices
(.pdf - 8.8KB)
All new patients must complete this form. Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
DEAR PATIENT: THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
At Carolina Orthopaedic Center, P.C., we are committed to treating and using protected health information about you responsibly. This Notice describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information.
This Notice is effective April 14, 2003 and applies to all protected health information as defined by federal regulations.
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Blue Cross Blue Shield Accident Questionnaire
(.pdf - 20k)
This form must be completed by all Blue Cross Blue Shield patients. |
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These forms are available in .pdf format and require Adobe Acrobat. Click the link at left to download a free version of Acrobat Reader. |
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