Lehighton Family Medicine
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New Patient Medical History and Questionnaire - your medical history, allergies and more.
Your input here will help us to treat you and to understand your current state of health.
Release of Medical Records - use this form to have your medical records transferred to
Lehighton Family Medicine. Complete the form and we will contact your previous provider for
you to ask for copies of your medical records.
Notice of Privacy Practices (HIPPA) - we are required by law to maintain the privacy of your
personal health information and provide you with notice of our legal duties and privacy
practices.
Acknowledgement of Privacy Practices - you are required to acknowledge receipt of the
above-mentioned Notice of Privacy Practices.
Financial Policy - so there are not surprises later, you are required to read and acknowledge
the Lehighton Family Medicine Financial Policy
YOU MAY DOWNLOAD ALL FORMS HERE
All above pdf forms require Adobe Reader.
Your input here will help us to treat you and to understand your current state of health.
Release of Medical Records - use this form to have your medical records transferred to
Lehighton Family Medicine. Complete the form and we will contact your previous provider for
you to ask for copies of your medical records.
Notice of Privacy Practices (HIPPA) - we are required by law to maintain the privacy of your
personal health information and provide you with notice of our legal duties and privacy
practices.
Acknowledgement of Privacy Practices - you are required to acknowledge receipt of the
above-mentioned Notice of Privacy Practices.
Financial Policy - so there are not surprises later, you are required to read and acknowledge
the Lehighton Family Medicine Financial Policy
YOU MAY DOWNLOAD ALL FORMS HERE
All above pdf forms require Adobe Reader.
We will arrange to have your medical records transferred to our office We ask that you please read our Financial Policy |
Kenneth Sharp, DO
Board Certified Family Medicine
Board Certified Family Medicine
| Other Downloads Instructions for Life A few words of wisdom from the Dalai Lama that we should all take to heart. You will find this hanging in our waiting room. Desiderata This very old, but 'healthy' document (dated 1692) was found in Old St Paul's Church in Baltimore. 9 Principles, 12 Values Political parties and issues set aside, these are sound principles and values that all Americans should subscribe to. |