Patient Forms & Checklist

 

Patient Forms: 

Optional Forms:
Disability Form (pdf)
Handicap Parking Form (pdf) 
Medical Records Release Form(pdf)

 

Patient ChecklistGETTING THE MOST OUT OF A VISIT WITH YOUR DOCTOR

Your visit with an orthopedic surgeon is an important meeting that can be most effective if you plan ahead. It is important that you give your doctor the information he or she needs and that you understand what your doctor is recommending. The following checklist will help you get the most out of your visit:

BEFORE YOU GO TO YOUR VISIT

  • If you are a new patient or being seen for a new complaint and have not completed the Phreesia online pre-visit interview questions prior to your visit, please arrive 30 minutes before your scheduled appointment time to complete the Phreesia pad interview and additional forms. This information – including insurance information, past medical history, and details of current problem(s) – provides valuable information for the physician and will enable us to establish a history and administrative file for you. 
  • Already completed the Phreesia online pre-visit interview? Then please arrive 15 minutes before your scheduled appointment time to fill out the additional practice forms. 
  • Please bring all necessary X-Rays, MRIs, CT scans or medical records to your visit relating to your ailment. 
  • If you need a translator, ask another adult to come with you, please do not rely on a child to translate.

DURING YOUR DOCTOR'S OFFICE VISIT

  • Be honest and complete in talking with your doctor. Share your point of view and do not hold back information about issues such as incontinence, memory loss, sex, weight loss or gain, or other issues that you might consider embarrassing. 
  • Take notes on what the doctor tells you, and ask questions if you don't understand the meaning of a word or the instructions for taking medications. 
  • Ask you doctor for handouts, brochures, references, and websites for you and your family to review at home. You can find great patient education and videos of your conditions on our website.

WHEN YOU GO HOME

  • Call the office and speak to a member of your health care team if you have further questions or if you did not understand something from your visit. We are here to make you a more informed patient in order to improve on your outcomes. 
  • Take the full course of medication and make sure you follow the prescribed diet / exercise routine. Remember, you are a part of your health care team as well! 
  • Keep your doctor informed of any changes in your condition.

COMMON QUESTIONS TO ASK IF YOUR DOCTOR RECOMMENDS SURGERY 

  • Why is the procedure being recommended? Are there any alternatives? 
  • What are the risks involved?
  • What is the procedure called? How is it performed? Do you have any video examples? 
  • What will happen if I don't have the surgery now? 
  • If I want a 2nd opinion, whom can I consult? 
  • How many similar procedures have been done by my surgeon? What are the patient outcomes? 
  • Will I need any tests or medical evaluations prior to the surgery? 
  • What kind of anesthesia will be used? 
  • What hospitals does my surgeon operate out of? What is their infection rates? 
  • What kind of implant or prosthesis will be used? How long will it last? 
  • What is the recovery process? How long will I be in the hospital? 
  • Will I need physical therapy after the procedure is completed? How long is the rehabilitation process? 
  • When can I return to work? 
  •  When can I drive my car? 
  • When can I have sexual activity? 
  • Are there any brochures / handouts / references that further explain the surgical procedure?

If you decide to go ahead with the surgery, check with your insurance company to see if your coverage requires you to obtain a managed care medical evaluation or clearance before the surgery. You should also verify that the surgery is covered by your policy and find out how your claim will be handled and paid.

New rules concerning prescriptions for controlled substances 

We are required by law to notify our patients about a new law that has gone into effect state wide with regard to the reporting of controlled substances. The Colorado State Legislature is now requiring pharmacies to report all prescriptions for controlled substances, including cough medications containing codeine or hydrocodone, prescription pain medication, sleeping pills, and many medications for ADHD, to a public database. The information pharmacies are required to report includes patient name, birth date, address, doctor name, payment method, drug name, refills, etc. The information can only be accessed by state regulatory boards, doctors, and law enforcement agencies.  

 

 

 

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Longmont  •  Lafayette  •  Frederick     303-772-1600 
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