Post Falls Family Medicine, PA
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(208) 773-1577
(208) 773-8585
1220 E. Polston Ave., Post Falls, ID 83854
Mon-Wed 7-6, Thurs 7-5, Fri 7-4

Forms

New Patient Forms

All of our forms are conveniently available for you to view and print. If you are new to our practice, we ask that you fill out a new patient packet prior to coming to your appointment to save time during the check in process.

 

 

 

Office Policies

This form is required of all patients because it authorizes Post Falls Family Medicine to release medical, billing and appointment information to family members in lieu of the patient. It also authorizes us to leave lab results on a voicemail or answering machine if the patient authorizes us to do so. Signing this form also acknowledges that you have read and understand our no show/missed appointment policy.

Download Office Policies Form pdf

 

Authorization to Receive Medical Information

This form allows Post Falls Family Medicine to request your medical records to another physician's office.

Download Authorization to Receive Medical Information pdf

 

Notice of Privacy Practices/HIPAA

This form documents the patient's receipt of the Notice of the Privacy Practices/HIPAA.

Download HIPAA pdf

 

Patient Demographic

This is required for new patients or patients that are re-establishing care with our office.

Download Patient Demographic pdf

 

We have mainstreamed our demographics for families that have more than one child, you now only need to fill out one demographic form for multiple children.

 Download Children(s) Demographic.pdf

 

Pre-History Form

This form gathers past medical history on new patients or patients who have not been in the office recently. This past medical history includes family illness, past and current medications, surgeries and selected procedures as well as social activities with risk factors.

Download Pre-History pdf

 

Financial Policy Form

Download Financial Policy pdf