Listing of permits and forms

Listing of permits and forms


 TRACY'S SUPER FORM - 2012

Tracy's Superior Health Plan Auth. Form

Tracy's Speedball H&P

(Strahan) 

Tracy's Speedball Orders

 (Strahan)

Tracy's Open Imaging Form

Tracy's Surgery Instructions for Patients

 Tracy's Fax Cover Sheet

 Tracy's Linden Order Form

 Tracy's Medical Clearance Form

Case Management Form : GSMC-M

Patient Information Booklets

 ADVANCED BENEFICIARY NOTICE

DJ ORTHO ANKLE FOOT BRACE - LTR. MED NECESSITY

CARDINAL PHARMA ORDER SHEET

REFERRAL GUIDE

 BLANK PRESCRIPTION [ALL 3 DRS. ON IT]

X-RAY PREGNANCY FORM

 GSMC OUTPATIENT ORDER FORM [WRITE-IN]

GSMC RADIOLOGY - DUNCAN

GSMC RADIOLOGY - WALDMAN

GSMC RADIOLOGY - STRAHAN

[CLICK HERE FOR A PAGE FULL OF PERMITS]

 PERMZILLA!                 PDF

STUPID BLOOD CONSENT 2016

RELEASE OF INFORMATION FORM

PHONE LIST - HOSPITAL AND DRUGSTORES          pdf       

FAX COVER SHEET              PDF 

FRONT DESK NEW PATIENT FORM      PDF

MAP TO OFFICE FROM HOSPITAL

CAST CARE INSTRUCTIONS

BRACE INSTRUCTIONS

ARTHRITIS MEDICINE WARNINGS

ANTI-INFLAMMATORY CREAMS

INSTRUCTIONS AFTER INJECTIONS

MRI INFORMATION FOR PATIENTS     [OPEN IMAGING]

MRI INFORMATION FOR PATIENTS      [GSMC-MARSHALL]

EUFLEXXA Rx - RIGHT

EUFLEXXA Rx - LEFT

EUFLEXXA Rx - BILATERAL

EUFLEXXA AUTHORIZATION - MALE

EUFLEXXA AUTHORIZATION - FEMALE

EUFLEXXA INSTRUCTIONS - DAW        PDF

AUTHORIZATION FOR INJECTION

EUFLEXXA PATIENT INSTRUCTIONS

EUFLEXXA PATIENT AUTHORIZATION FORM

SPEEDBALL ETMC X RAY PRESCRIPTION

AUTOMATIC TRANSLATOR !

X RAY SCHEDULING - DW

 REFERRAL SCHEDULING - DW        PDF 

ABX AFTER JOINT REPLACEMENT

VTR 214               WH 380 E                WH 380 F.

...........................................................................................

 SPEEDBALL HOSPITAL PROGRESS NOTE      PDF

 SPEEDBALL HOSPITAL DISCHARGE PROGRESS NOTE

OFFICE NOTE          

Office note PDF

X-RAY PULL SHEET

NURSING HOME NOTE          X-RAY          PDF

lab speedball              PDF                 

x-ray speedball

 speedball dj ortho dme cmn form

----------------------------------------------------

speedball ER routing sheet        PDF

speedball ortho h&p          PDF    

speedball surgery booking sheet

 PDF speedball surgery booking sheet

speedball admit orders - pg. 1       PDF

speedball adult admit orders - page 2

speedball admit orders - surgery today

speedball admit orders -- surgery today -- page 2 

speedball admit orders - surgery today - pdf

speedball additional admit orders
    PDF

speedball orders - text area

speedball orders - text area - pdf

speedball pca sheet       PDF

 intra-op orders - form

intra op orders - form - pdf

sliding scale

sliding scale - PDF

speedball additional orders -signed

speedball hip admit orders____PDF

speedball snf admit orders

speedball orders as consultant

pdf orders as consultant

speedball standard discharge orders       

 speedball standard discharge orders --dd

 pdf discharge orders

 hospital discharge instructions

speedball FOR CONSULTANT-- OK FOR SURGERY ??

speedball adult major postop orders - page 1

speedball adult major postop orders - page 2

pdf postop orders

vancomycin rationale

speedball additional admit orders

speedball postop note_____PDF

speedball pca sheet

 speedball pca sheet - signed

speedball adult minor postop orders    PDF

speedball cfnb "forgotten" orders

care path       PDF

care path progress notes

speedball consult form

speedball consult form - PDF

speedball DME Rx 

speedball DME Rx - PDF

speedball excuse

 speedball excuse - PDF

speedball - to whom it may concern

PDF - To Whom it May Concern

speedball PT slip              PDF 

speedball PT letterhead

speedball prescription    ofc    PDF

speedball prescription - blank 

 speedball prescription -blank - office 

DOCUMENTATION OF Rx

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LEGACY FORMS -- THE ONES YOU FILL OUT BY HAND

------------------------------------------------------------------

 icd and cpt         ten day global         lacerations

icd alone, with cpt modifiers

uncommon icd

COMMONLY USED ANTIBIOTICS

 OKU-9 INFECTION TREATMENT GUIDELINES

DVT PROPHYLAXIS

 GSMC-M FORMULARY - 2008

preop lab and npo guidelines

workup of bone lesions

DICTATION SYSTEM INSTRUCTIONS

FRESH AIR

photo of synthes wrist fixator

hip fracture diagram

hip fracture repair

-------------------------------------------

ROUTING SHEETS

 brace              cast        injection    

schedule      x ray - ofc       x ray - outside

knee exercises          shoulder exercises

physical therapy slip

ice massage

CPOE ERRATA

DAW                                                                                        

         

copyright 2010   D. Waldman, MD

psd

new phone list 2015