Post Falls Family Medicine, PA
Facebook
(208) 773-1577
(208) 773-8585
1220 E. Polston Ave., Post Falls, ID 83854
Mon-Thu 7am to 6pm, Fri 7am to 4pm

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.

 

 

 

New Patient Packet

If you are a new patient to our office, Post Falls Family Medicine requires you to fill out the following forms: Patient Demographic, Pre-History, Release of Information, No Show Policy, and a Notice of Privacy Practice (HIPAA) form.

Download Our New Patient Packet pdf

 

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 Release Medical Information

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

Download Authorization to Release Medical Information pdf

 

Authorization to Receive Medical Information

This form allows Post Falls Family Medicine to request your records from 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

 

Consent for Vasectomy

Download Consent for Vasectomy pdf

 

Coumadin (Warfarin) patient agreement

Download Coumadin (Warfarin) patient agreement pdf

 

Sports Physical Form

Download Sports Physical Form pdf

 

Pain Management Agreement

Download Pain Management Agreement pdf