BMI THE HAMPSHIRE CLINIC is part of BMI Healthcare, the UK s largest provider of independent healthcare*

Size: px
Start display at page:

Download "BMI THE HAMPSHIRE CLINIC is part of BMI Healthcare, the UK s largest provider of independent healthcare*"

Transcription

1

2 BMI THE HAMPSHIRE CLINIC is part of BMI Healthcare, the UK s largest provider of independent healthcare* Consultant care 98.7% satisfaction** At BMI Healthcare, we have over 59 hospitals and healthcare facilities nationwide. Throughout these locations, we treat more than 300,000 patients and manage over one and a half million outpatient visits every year, offering a wealth of experience, highly complex surgery, a patient-centred approach and access to some highly specialised consultants. BMI The Hampshire Clinic also has access to some of the latest technology and equipment, including: Nursing care 95.6% satisfaction** 65 beds with all rooms offering the privacy and comfort of en-suite facilities, satellite TV, telephone and Wi-Fi 20 consulting rooms Four operating theatres Diagnostic imaging X-ray MRI and CT scanner Ultrasound Mammography Overall quality 98.8% of care satisfaction*** Brand new Endoscopy unit open January 2018 Physiotherapy Hydrotherapy complex Level 3 critical care facility Health screening On-site pharmacy BMI Healthcare is proud of its consistently low hospital infection rates for MRSA bacteraemia and Clostridium difficile. This is achieved by a carefully planned regime of rigorous infection prevention policies, surveillance, training and exceptionally high standards of cleaning. *Based on the number of hospitals/treatment centres within the UK - September **Satisfaction figures are based on patients giving a rating of 'very good' or 'excellent' of a sample of 809 completing a questionnaire over the period October 2016 September ***Overall quality of care score is based on patients giving a rating of 'very good' or 'excellent' of a sample of 3017 completing a questionnaire over the period October 2016 September ****Friends and Family recommendation figures are based on 3018 patients saying that they are 'extremely likely / likely' to recommend the hospital to friends and family over the period October 2016 September Questionnaires analysed by Quality Health, who are an independent survey provider. 98.9% of our patients say that they would recommend the hospital to friends and family****

3

4

5 CONSULTANT SUB SPECIALTY / SPECIAL INTEREST TELEPHONE NHS ALLERGY Dr S Jog (F) General paediatrics, respiratory, allergy and rheumatology, comprehensive assessment of newborn to teenagers. Reflux, growth issues, allergy, eczema, asthma, cough, bowel problems, fits/faints, murmur, urinary infection, Joint problems & paediatrics M F Dr R Turner (M) Paediatric and adult general allergy, anaphylaxis T BARIATRIC SURGERY Mr N Carter (M) Weight loss, bariatric, revisional bariatric, sleeve gastrectomy, gastric band, gastric bypass, gastric balloon Portsmouth NHS Trust Mr B Knight (M) Weight loss, bariatric, revisional bariatric, sleeve gastrectomy, gastric band, gastric bypass, gastric baloon, laparoscopic anti reflux surgery, hernia surgery, complex biliary disease Portsmouth NHS Trust BREAST SURGERY Mr K Harris (M) Breast and oncological surgery, breast reconstruction surgery, cosmetic surgery, thyroid and parathyroid surgery, hernia repair, melanoma and skin cancer surgery, lumps and bumps (lesions of skin) T Ms S Laws (F) Breast and general surgery T CARDIOLOGY Dr A Bishop (M) General cardiology including coronary angioplasty, pacemaker implantation and hypertension T Dr C Brookes (M) Angiography, interventional angioplasty, pacemaker implantation, heart failure and all forms of heart disease Dr D Kelly (M) General cardiology, coronary angiography, cardiac failure, monitoring and insertions Dr M Scheuermann- Freestone (F) Multimodality cardiac imaging including echo, stress echo, TOE/3D TOE, cardiac MRI and cardiac CT DERMATOLOGY Dr J Holder (F) General dermatology - including psoriasis, eczema, acne, rosacea. Contact dermatitis - patch testing, skin cancer, mole checks, benign skin lesions and laser M DIETETICS Mrs J Benham-Crosswell (F) Dietician T F Mr D Swain (M) Dietician T F ENT SURGERY Mr J Blanshard (M) Otology, paediatric ENT, voice disorders T F Mr P Spraggs (M) Management of benign and malignant conditions of the head and neck including skin cancers, neck lumps, thyroid disorders and nodules and parathyroid surgery. Rhinoplasty for both functional and cosmetic nasal problems, correction of bat ears T GASTROENTEROLOGY Dr N Afzal (M) Gastroenterologist, paediatric endoscopist (diagnostic and therapeutic) - gastroscopy, ileocolonoscopy and polypectomy, nutrition in children, growth issues, bowel problems in infancy, feeding issues, inflammatory bowel disease, bowel allergies, coeliac disease, diarrhorea, reflux, refractory constipation, bleeding from the bowel, bowel conditions related to other diagnoses and conditions, other complex bowel issues and general paediatrics T F UHS Southampton FT Prof J Ramage (M) Gastro-intestinal disease, neuroendocrine tumours, cancer diagnosis, colitis, coeliac disease, hepatology and liver disease and capsule endoscopies T F Dr M Reynolds (M) General medicine, upper GI endoscopy (gastroscopy), upper GI endoscopy and dilatation, inserting an oesophageal stent (endoscopy), percutaneous endoscopic gastrostomy (PEG) T F Dr R Saich (F) Gastroenterology, hepatology, inflammatory bowel disease and endoscopy T F Referral Hotline

6 CONSULTANT SUB SPECIALTY / SPECIAL INTEREST TELEPHONE NHS GENERAL MEDICINE Dr S Arianayagam (M) General physician, parkinson's disease, falls, cerebrovascular disease, ortho-geriatrics, cognitive dysfunction/ dementia, syncope and elderly care medicine T F Dr S Matti (M) Chest medicine, sleep apnoea T Prof J Ramage (M) Gastro-intestinal disease, neuroendocrine tumours, cancer diagnosis, colitis, coeliac disease, hepatology and liver disease and capsule endoscopies T F GENERAL SURGERY Mr S Arnold (M) General & colorectal surgery open & laparoscopic surgery, change in bowel habit, abdominal pain, colorectal cancer, diverticular disease, crohn s, hernia repair, rectal bleeding, anal fistula & fissure, haemorrhoids, pilonidal disease, lumps, bumps T F Mr T Cecil (M) General & colorectal surgery open and laparoscopic surgery, including change in bowel habit, abdominal pain, colorectal cancer, diverticular disease, hernia repair, rectal bleeding,pseudomyxoma peritonei, peritoneal malignancy T F Mr B Cresswell (M) Hepatopancreatobiliary and laparoscopic surgery, gallstones/gallbladder disease & cholecystectomy, liver cancer (primary and secondary), pancreatic cancer, pancreatitis, hernia, upper GI endoscopy, "lumps & bumps", abdominal pain T F Mr S Dayal (M) General & colorectal surgery open and laparoscopic surgery, including change in bowel habit, abdominal pain, colorectal cancer, diverticular disease, hernia repair, rectal bleeding, pseudomyxoma peritonei, peritoneal malignancy T F Mr F DiFabio (M) General & colorectal surgery open and laparoscopic surgery, bowel cancer surgery, colonoscopy, rectal bleeding, change in bowel habit Mr K Harris (M) Breast surgery, hernia repair, melanoma and skin cancer surgery, lumps and bumps (lesions of skin), thyroid and parathyroid surgery T Mr T John (M) Laparoscopic surgery, upper GI Mr F Mohamed (M) General & colorectal surgery open and laparoscopic surgery, including change in bowel habit, abdominal pain, colorectal cancer, diverticular disease, rectal bleeding, open hernia repair, pseudomyxoma peritonei, peritoneal malignancy T F Mr B Moran (M) General & colorectal surgery, including rectal and colorectal cancer, change in bowel habit, abdominal pain, rectal bleeding, diverticular disease, hernia repair, pseudomyxoma peritonei, peritoneal malignancy T F Mr M Rees (M) Hepatobiliary surgery (Liver cancer primary and secondary) gallstones/ gallbladder disease and cholecystectomy, hernias, varicose veins, skin lesions T F Mr A Venkatasubramaniam (M) General & colorectal surgery open & laparoscopic surgery, change in bowel habit, abdominal pain, pelvic floor dysfunction, rectal prolapse & bleeding, faecal incontinence, colorectal cancer, diverticular disease, hernia repair, anal fistula & fissure T F Miss F Welsh (F) Hepatobiliary surgery, gallstone disease, primary and secondary liver cancer, laparoscopic and open hernia surgery T F GYNAECOLOGY Miss N Gauthaman (F) General gynaecology and womens health issues, urogynaecology and female pelvic floor reconstruction T Mr G Goumalatsos (M) General gynaecology inc minimal access surgery T F Mr C Phillips (M) Urogynaecology, urodynamics, minimally invasive surgery, gynaecological ultrasound, early pregnancy scanning, general gynaecology T F Miss A Sohail (F) General gynaecology, menstrual disorders, early pregnancy complications including recurrent miscarriages and gynaecological & obstetric ultrasound scanning and laparoscopic surgery T F Referral Hotline

7

8 CONSULTANT SUB SPECIALTY / SPECIAL INTEREST TELEPHONE NHS NEUROLOGY Dr R Arunachalam (M) Nerve conduction studies, electromyography, single fibre EMG, direct muscle stimulation, transcranial magnetic stimulation, routine and ambulatory EEG (electroencephalography), evoked potential studies (visual, auditory and somatosensory), MSLT T Southampton Dr L Kinton (F) General neurology, headache, epilepsy M F / Southampton Dr A Kurian (M) Clinical neurophysiology and specialises in, EMG, nerve conduction studies, carpal tunnel syndrome and peripheral neuropathy F Southampton NEUROSURGERY Dr A Miller (M) All neurology symptoms or conditions including weakness, numbness, headache, memory impairment, loss of consciousness, dizziness and tremor plus neuromuscular diseases (conditions of peripheral nerve, neuromuscular junction and muscle) ONCOLOGY Dr C Rees (F) Gastro-intestinal cancers T and UHSFT Dr S Tinkler (F) Breast and gynaecological cancers T T F / Southampton OPHTHALMOLOGY Mr J Greenwood (M) Cataract surgery, refractive lens exchange surgery, general ophthalmic surgery T F Mr S Keightley (M) General ophthalmology, cataracts, diabetic eye disease, vision and driving T F Mr C Sandy (M) Cataract surgery, small incision sutureless cataract surgery under topical anaesthesia using standard, toric and multifocal lenses. Eyelid surgery (cosmetic and reconstructive), watery eye management, general ophthalmology T F ORAL/MAXILLOFACIAL SURGERY Mr M Bater (M) Removal retained roots / wisdom teeth, treatment of mouth ulcers, patches and lumps, excision of facial skin lesions and cancers, management of facial pain / TMJ problems, treatment of salivary gland disorders, diagnosis and treatment of mouth cancer T & RSCH Mr J D Souza (M) Dental and third molar surgery, oral lumps and bumps, skin lumps and bumps, salivary gland disease, head & neck cancer surgery T Royal Surrey County ORTHOPAEDIC SURGERY Mr D Avis (M) Hand and wrist surgery T Mr T Briant-Evans (M) Primary & revision hip replacement surgery, hip injections, young adult hip pian. Knee arthroscopy, partial and total knee replacement surgery T Mr J Britton (M) Hip and knee replacement, shoulder and upper limb surgery T F Mr J Calder (M) Foot and ankle surgery T F Mr K Conn (M) Knee, hip, foot and ankle surgery T F Mr R Elliot (M) Adult foot and ankle disorders, sports injuries of the foot and ankle, foot and ankle trauma T F Mr J Griffiths (M) Hip injection therapies, primary and revision total knee replacement surgery, partial knee replacements, knee arthroscopy, knee, injection therapies, enhanced recovery (ERP) following lower limb surgery T Mr R Harker (M) Hip and spinal surgery T F Mr J Hobby (M) Hand and upper limb T Referral Hotline

9 CONSULTANT SUB SPECIALTY / SPECIAL INTEREST TELEPHONE NHS Mr R Pickard (M) Spinal surgery and non-operative pain control T Frimley Health Mr A Quaile (M) Spinal disorders and non-operative treatment. T F Mr M Risebury (M) Total knee replacement, revision total knee surgery, ACL reconstruction surgery, multi ligament reconstruction surgery, arthroscopic, knee surgery, osteotomy surgery T Mr P Rosell (M) Shoulder and elbow surgery, shoulder replacement, shoulder arthroscopy, arthroscopic stabilisation and rotator cuff surgery, shoulder and elbow sports surgery T Frimley Park Mr N Rossiter (M) Orthopaedic trauma, all knee surgery, soft tissue shoulder surgery T F Mr D Simon (M) Shoulder, elbow, wrist and hand surgery, trauma T F Mr G Stranks (M) Hip and knee disorders including revision and complex joint replacements, hand surgery and general orthopaedics T F Professor A Wilson (M) ACL repair and reconstruction, sports injuries to the knee & all aspects of soft tissue & reconstructive knee surgery, child knee injuries, cartilage surgery, meniscal surgery, patella stabilisation, knee replacement & realignment surgery/osteotomy T Mr S Yasen (M) Knee & Hip including sports injuries. ACL Reconstruction, osteotomy, hip Injection treatment, knee arthroscopy, knee replacement, hip replacement and lower limb reconstruction T OUTPATIENT SERVICES Dr D Cook (M) Occupational health physician T Mr I Harrison (M) Musculo-skeletal pain, joint stiffness and bio-mechanical problems. Most common referrals - back, neck and shoulder pain T Mr G Linscott (M) Chiropractic T Mr P Williams (M) Podiatrist, special Interest in foot and ankle pain and children's knee pain in sport T PAEDIATRICS Dr N Afzal (M) Gastroenterologist, paediatric endoscopist (diagnostic and therapeutic) - gastroscopy, ileocolonoscopy and polypectomy, nutrition in children, growth issues, bowel problems in infancy, feeding issues, inflammatory bowel disease, bowel allergies, coeliac disease, diarrhorea, reflux, refractory constipation, bleeding from the bowel, bowel conditions related to other diagnoses and conditions, other complex bowel issues and general paediatrics T F UHS Southampton FT Mr N Hall (M) All outpatient and inpatient care for general paediatric surgical conditions including skin lesions, groin hernia, hydrocele, appendicitis, umbilical hernia, undescended testis, circumcision and tongue tie T Southampton Mrs N Heather (F) Dietitian specialising in paediatrics M T Southampton Dr S Jog (F) General paediatrics, respiratory, allergy and rheumatology, comprehensive assessment of newborn to teenagers. Reflux, growth issues, allergy, eczema, asthma, cough, bowel problems, fits/faints, murmur, urinary infection, Joint problems & paediatrics M F Ms D Nicol (F) Cognitive behavioural therapist, cognitive behavioural assessment and treatment (adult and children) PAIN MEDICINE Dr D Aldington (M) Pain management, low back and neck pain, post-surgical pain, nerve pain T Dr C Seifert (M) Chronic pain management T PLASTIC, RECONSTRUCTIVE AND COSMETIC SURGERY Mr D Crawford (M) Cosmetic surgery including breast reduction, breast augmentation, breast uplift, full face lift, mini face lift and tummy tuck/abdominoplasty T F Mr K Harris (M) Breast reconstruction, oncology T Mr C Kerawala (M) Head & neck cancer, trans-oral robotic surgery, facial reconstruction, minimally-invasive salivary gland techniques, facial skin cancer, removal of buried roots/ wisdom teeth, oral patches & lumps, cosmetic facial surgical & non-surgical treatment T Royal Marsden Referral Hotline

10 CONSULTANT SUB SPECIALTY / SPECIAL INTEREST TELEPHONE NHS Mr P Spraggs (M) Rhinoplasty for cosmetic and functional nasal deformity, skin cancer surgery, otoplasty for correction of bat ears T F Mr I Whitworth (M) Cosmetic surgery T Salisbury PSYCHIATRY Dr S Rathod (F) Mental health problems - anxiety, adjustment, work stress, panic, phobia, depression, bipolar, loss, trauma, emotional instability, psychosis, alcohol, substance use and chronic pain M Southern Health NHS Foundation Trust Ms D Nicol (F) Cognitive behavioural therapist, cognitive behavioural assessment and treatment (adult and children) Dr M Slaney (M) General adult psychiatrist T F RADIOLOGY Dr D Bailey (M) Musculoskeletal radiology Including digagnostic and therapeutic interventional proceedures under imgagng guidance. Military & terrorist trauma imaging T Dr J Brant (M) Cross sectional body imaging and internal diagnostic medicine T Dr P Chapman (M) Imaging and image guided treatment of sports injuries T Dr S Dixon (F) Interventional radiology in vascular and non-vascular interventions T Dr I Green (M) Ultrasound T Dr H Griffith (F) X-rays and scans including ultrasound T Dr N Lyle (F) Radiology T Dr H ONeill (F) General radiology, cross sectional imaging and barium and contrast studies T Dr D Peppercorn (F) Body imaging, particularly hepatobiliary, and rectal MR and musculoskeletal MR T Dr A Thrower (M) Gastrointestinal radiology using ultrasound, CT, MRI and fluoroscopy, including hepatobiliary imaging, virtual (CT) colonoscopy, small bowel imaging, peritoneal malignancy, non-vascular intervention and pelvic floor imaging T Dr G Ubhayakar (M) Interventional radiology T Dr D Wright (F) General imaging T RHEUMATOLOGY Dr S Jog (F) General paediatrics, respiratory, allergy and rheumatology, comprehensive assessment of newborn to teenagers. Reflux, growth issues, allergy, eczema, asthma, cough, bowel problems, fits/faints, murmur, urinary infection, Joint problems & paediatrics M F Dr R Moitra (M) Osteoporosis, inflammatory arthritis, musculoskeletal medicine T Dr P Prouse (M) Osteoporosis, metabolic bone disease, rheumatology including paediatric rheumatology T F UROLOGY Professor C Eden (M) General urology, benign and malignant prostate diseases, retzius-sparing robotic radical prostatectomy T RSCH Mr R Hindley (M) Minimally invasive and laparoscopic urology, urolift, rezum and greenlight laser prostate surgery, prostate cancer diagnostics, HIFU treatment, renal cancer, men s health issues T F Mr H Mostafid (M) Bladder cancer, robotic radical cystectomy, minimally invasive stone surgery, urinary tract infection T RSCH and Mr T Nedas (M) Kidney stone disease, general urology and general paediatric urology T F VARICOSE VEINS Mr M Rees (M) Hepatobiliary surgery (Liver cancer primary and secondary) gallstones/ gallbladder disease and cholecystectomy, hernias, varicose veins, skin lesions T F Dr S Tristram (M) Varicose vein treatment and venous ulcer management and prevention T Referral Hotline

11 CONSULTANT SUB SPECIALTY / SPECIAL INTEREST TELEPHONE NHS Referral Hotline

12

13

94.9% met or exceeded** 83.7% satisfaction** 97.3% of care satisfaction***

94.9% met or exceeded** 83.7% satisfaction** 97.3% of care satisfaction*** BMI THE HAMPSHIRE CLINIC is part of BMI Healthcare, the UK s largest provider of independent healthcare* Expectations 94.9% met or exceeded** At BMI Healthcare, we have over 59 hospitals and healthcare

More information

Referral routes into Secondary Care by Specialty and Clinic January 2017

Referral routes into Secondary Care by Specialty and Clinic January 2017 Referral routes into Secondary Care by Specialty and Clinic January 2017 C&B specialty Clinic / Comments Breast (from 7 th November 2016) (for other symptomatic see Surgery-Breast) Referral route ENT (from

More information

Referral routes into Secondary Care by Specialty and Clinic November 2017

Referral routes into Secondary Care by Specialty and Clinic November 2017 Referral routes into Secondary Care by Specialty and Clinic November 2017 C&B specialty Clinic / Comments Breast (from 7 th November 2016) (for other symptomatic see Surgery-Breast) July 2016 Referral

More information

Cover Comparison for AAMI Health Insurance Basic Hospital Plus

Cover Comparison for AAMI Health Insurance Basic Hospital Plus Cover Comparison for AAMI Health Insurance Basic Hospital Plus Summary of changes effective 1 April 2019 Product AAMI Health Insurance Basic Hospital Plus (previously AAMI Health Insurance Starter Hospital)

More information

Live Services on Advice and Guidance on e-referrals as of 02/03/18

Live Services on Advice and Guidance on e-referrals as of 02/03/18 Speciality Service Children's & Adolescent Services ( 420 ) Children's Dermatology @ Croydon University Hospital-RJ6 (ID 7908356) Children's & Adolescent Services ( 420 ) Paediatric Sickle Cell and Thalassaemia

More information

BMI THE DUCHY HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare*

BMI THE DUCHY HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* BMI THE DUCHY HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* Consultant care 99.4% satisfaction** At BMI Healthcare, we have over 59 hospitals and healthcare facilities

More information

Cover Comparison for AAMI Health Insurance Silver Everyday Hospital Plus

Cover Comparison for AAMI Health Insurance Silver Everyday Hospital Plus Cover Comparison for AAMI Health Insurance Silver Everyday Hospital Plus Summary of changes effective 1 April 2019 Product AAMI Health Insurance Silver Everyday Hospital Plus (previously AAMI Health Insurance

More information

Cover Comparison for AAMI Health Insurance Bronze Hospital Plus

Cover Comparison for AAMI Health Insurance Bronze Hospital Plus Cover Comparison for AAMI Health Insurance Bronze Hospital Plus Summary of changes effective 1 April 2019 Product Hospital Services Added Hospital Services Removed AAMI Health Insurance Bronze Hospital

More information

96.5% met or exceeded** 91.4% of care satisfaction*** 98.2% satisfaction****

96.5% met or exceeded** 91.4% of care satisfaction*** 98.2% satisfaction**** BMI WOODLANDS HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* Expectations 96.5% met or exceeded** At BMI Healthcare, we have over 59 hospitals and healthcare facilities

More information

BMI WOODLANDS HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare*

BMI WOODLANDS HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* BMI WOODLANDS HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* Consultant care 99.1% satisfaction** At BMI Healthcare, we have over 59 hospitals and healthcare facilities

More information

93.9% met or exceeded** 91.7% satisfaction** 97.0% of care satisfaction***

93.9% met or exceeded** 91.7% satisfaction** 97.0% of care satisfaction*** BMI THE HUDDERSFIELD HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* Expectations 93.9% met or exceeded** At BMI Healthcare, we have over 59 hospitals and healthcare

More information

Rowley Hall Hospital. GP Referral Guide. for Private and NHS patients. Rowley Hall Hospital

Rowley Hall Hospital. GP Referral Guide. for Private and NHS patients. Rowley Hall Hospital Rowley Hall Hospital GP Referral Guide for Private and NHS patients Rowley Hall Hospital About Rowley Hall Hospital Rowley Hall Hospital is a leading private hospital with an excellent reputation for delivering

More information

For the people of West Cork and surrounding areas. Information for patients and their families. Bantry Urgent Care Centre

For the people of West Cork and surrounding areas. Information for patients and their families. Bantry Urgent Care Centre Bantry Urgent Care Centre For the people of West Cork and surrounding areas Information for patients and their families The Bantry Urgent Care Centre is made up of a Local Injury Unit and a Medical Assessment

More information

New Patient Form. Patient Demographics. Emergency Information. Employment Information. Page 1 of 7. Family Health Chiropractic Care

New Patient Form. Patient Demographics. Emergency Information. Employment Information. Page 1 of 7. Family Health Chiropractic Care Page 1 of 7 Patient Demographics First Name* Last Name* Date Of Birth* Home Phone* Mobile Phone Phone Gender* Email Preferred Communication Street Address 1* Street Addresss 2 Zip* City* State* Emergency

More information

Premium Specialty: Pediatrics

Premium Specialty: Pediatrics Premium Specialty: Pediatrics Credentialed Specialties include: Adolescent Medicine, Pediatric Adolescent, and Pediatrics This document is designed to be used in conjunction with the UnitedHealth Premium

More information

BMI THE LANCASTER HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare*

BMI THE LANCASTER HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* BMI THE LANCASTER HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* Consultant care 99.5% satisfaction** Nursing care 98.9% satisfaction** At BMI Healthcare, we have

More information

BMI WERNDALE HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare*

BMI WERNDALE HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* BMI WERNDALE HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* Consultant care 99.3% satisfaction** At BMI Healthcare, we have over 55 hospitals and healthcare facilities

More information

CATÁLOGO DE SERVICIOS DEL CENTRO

CATÁLOGO DE SERVICIOS DEL CENTRO 1. ANGIOLOGY AND VASCULAR SURGERY. Varicose veins. CHIVA-Technique: Minimally invasive surgical treatment carried out with local anaesthetic and without hospital stay, resulting in minimal work leave.

More information

Partners in health A Unit of vps Health Care

Partners in health A Unit of vps Health Care Medeor Latin. Meaning: I heal World-class healthcare and an unparalleled patient experience. Who are we? We are a multi-speciality, 24x7, family hospital located in the heart of Abu Dhabi. We are committed

More information

94.2% met or exceeded** 94.4% of care satisfaction*** 89.9% satisfaction****

94.2% met or exceeded** 94.4% of care satisfaction*** 89.9% satisfaction**** BMI THE DUCHY HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* Expectations 94.2% met or exceeded** At BMI Healthcare, we have over 59 hospitals and healthcare facilities

More information

Appendix Five Volume of practice and workplace-based assessment requirements for the specialised study units

Appendix Five Volume of practice and workplace-based assessment requirements for the specialised study units Appendix Five and workplace-based assessment requirements for the specialised study units This appendix contains tables setting out both the volume of practice (VOP) and workplace-based assessment (WBA)

More information

RESIDENCY TRAINING PROGRAMME IN UROLOGY CERTIFICATION APPLICATION FORM PARTICIPATING INSTITUTE(S)

RESIDENCY TRAINING PROGRAMME IN UROLOGY CERTIFICATION APPLICATION FORM PARTICIPATING INSTITUTE(S) Date application Name primary institute RESIDENCY TRAINING PROGRAMME IN UROLOGY CERTIFICATION APPLICATION FORM Name affiliated institute(s) Name Programme Director PARTICIPATING INSTITUTE(S) This form

More information

SUPPLEMENTAL DIGITAL CONTENT 2 : SURGERY SUBGROUPS DEFINITONS AND DISTRIBUTION

SUPPLEMENTAL DIGITAL CONTENT 2 : SURGERY SUBGROUPS DEFINITONS AND DISTRIBUTION mortality 24h in ICU mortality 24h in ICU 1 SUPPLEMETAL DIGITAL COTET 2 : SURGERY SUBGROUPS DEFIITOS AD DISTRIBUTIO =2,717,902 GHM codes* Surgery description CARDIAC SURGERY 05C021 to 05C034 Cardiac valve(s)

More information

Concord Hospital Cost of Care Estimates

Concord Hospital Cost of Care Estimates Hospital Departments Laboratory Services Basic Metabolic Panel (BMP)(80048) $88 N/A $88 $35 Blood draw (36415) $29 N/A $29 $12 Complete blood cell count (CBC)(85025) $88 N/A $88 $35 Comprehensive Metabolic

More information

Radiology. General radiology department. X-ray

Radiology. General radiology department. X-ray The radiology directorate provides a diagnostic, interventional and therapeutic service for its local population, and a tertiary service for the region. It also provides support to some national work such

More information

Assisting in Other Medical Specialties

Assisting in Other Medical Specialties CHAPTER 42 Assisting in Other Medical Specialties 42-2 Learning Outcomes (cont.) 42.1 Describe the medical specialties of allergy, cardiology, dermatology, endocrinology, gastroenterology, neurology, oncology,

More information

HEALTH FACILITY SCOPE OF SERVICES

HEALTH FACILITY SCOPE OF SERVICES Kindly fill the herein form specifying the scope of services (inpatient and outpatient) provided by your institution and the present medical professionals level. Health Authority Abu Dhabi Facility Licensing

More information

Contributors. Thanks to Peter Miller, MD; LCDR Kevin Preston, MD; and Keith Newbrough, MD for their generous contribution of images:

Contributors. Thanks to Peter Miller, MD; LCDR Kevin Preston, MD; and Keith Newbrough, MD for their generous contribution of images: Contributors Thanks to Peter Miller, MD; LCDR Kevin Preston, MD; and Keith Newbrough, MD for their generous contribution of images: Peter Miller, MD, Indiana University School of Medicine Chapter 1: Figure

More information

Health History Questionnaire

Health History Questionnaire Health History Questionnaire Page 1 of 8 Thank you for choosing Martin s Point to be your partner in health. To help us give you the highest-quality care, please answer the questions on this form as well

More information

PREAMBLE GENERAL DIAGNOSTIC RADIOLOGY

PREAMBLE GENERAL DIAGNOSTIC RADIOLOGY PREAMBLE The General Diagnostic Radiology category is intended to cover the body of knowledge a practicing board certified Diagnostic Radiologist should know. Since the range of content relevant to the

More information

Vascular surgery is a specialty that deals with diseases of the vascular system (i.e. arteries, veins

Vascular surgery is a specialty that deals with diseases of the vascular system (i.e. arteries, veins Vascular Surgery Vascular surgery is a specialty that deals with diseases of the vascular system (i.e. arteries, veins and lymphatics). These are managed by medical therapy, interventional procedures,

More information

Rooms offering the privacy and comfort of ensuite facilities, TV. telephone and WIFI. Full physiotherapy suite including sports injury clinic

Rooms offering the privacy and comfort of ensuite facilities, TV. telephone and WIFI. Full physiotherapy suite including sports injury clinic BMI KINGS PARK HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* Expectations 96.6% met or exceeded** At BMI Healthcare, we have over 59 hospitals and healthcare

More information

Full physiotherapy suite including sports injury clinic. Endoscopy room with on-site decontamination

Full physiotherapy suite including sports injury clinic. Endoscopy room with on-site decontamination BMI FERNBRAE HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* Expectations 99.3% met or exceeded** At BMI Healthcare, we have over 59 hospitals and healthcare facilities

More information

97.3% met or exceeded** 96.1% satisfaction** 96.8% of care satisfaction**

97.3% met or exceeded** 96.1% satisfaction** 96.8% of care satisfaction** BMI SARUM ROAD HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* Expectations 97.3% met or exceeded** At BMI Healthcare, we have over 59 hospitals and healthcare

More information

ADULT HISTORY CURRENT STATUS 1.! 3. 2.! 4.

ADULT HISTORY CURRENT STATUS 1.! 3. 2.! 4. If you have any recent Radiologic Studies or Blood Work please bring it with you. ADULT HISTORY Name:!!! Date: D.O.B:!!! Age:!!!! M F CURRENT STATUS PRIMARY PROBLEMS: 1.! 3. 2.! 4. SYMPTOM DRAWING Please

More information

20 HOSPITAL S 17 TANDARD

20 HOSPITAL S 17 TANDARD 2017 This hospital plan offers extensive hospital benefits with some value-added benefits. Unlimited cover up to 100% in hospital 27 PMB chronic conditions covered Network specialists paid in full in hospital

More information

OUTPATIENT Surgery Estimates APPENDECTOMY-laparoscopic: $17, Open-none in 2018 in OPS setting OBS PTS (laparoscopic) $27,973.

OUTPATIENT Surgery Estimates APPENDECTOMY-laparoscopic: $17, Open-none in 2018 in OPS setting OBS PTS (laparoscopic) $27,973. OUTPATIENT Surgery Estimates 2019 APPENDECTOMY-laparoscopic: $17,852.53 Open-none in 2018 in OPS setting OBS PTS (laparoscopic) $27,973.96 BILATERAL TUBAL LIGATION Laparoscopic using clips: $17,193.28

More information

Long-stay patients methodology Published by NHS England and NHS Improvement

Long-stay patients methodology Published by NHS England and NHS Improvement Long-stay patients methodology Published by NHS England and NHS Improvement July 2018 1 Document Title: Long-stay patients methodology Version number: 1.0 First published: 9 July 2018 Updated: Prepared

More information

PRIMARY. Adult dependant. Main member. Child dependant R1 924 R1 505 R 613

PRIMARY. Adult dependant. Main member. Child dependant R1 924 R1 505 R 613 2017 This traditional option offers simple day-to-day benefits and hospital cover. Unlimited cover up to 100% in hospital Separate benefit for GP consultations Network specialists paid in full in hospital

More information

Oregon CPT Preapproval Grid

Oregon CPT Preapproval Grid Not Applicable Home Health Stays - For all Initial Certification and Recertification periods Notes: Initial Certification review required effective 1/1/12. Not Applicable Skilled Nursing Facility Stays

More information

Patient Intake Form for Allegany Ear, Nose, & Throat

Patient Intake Form for Allegany Ear, Nose, & Throat Patient Intake Form for Allegany Ear, se, & Throat Patient Name: What brings you to the office today? Who is your primary care doctor? Please list your current medications: Are you allergic to any medications?

More information

Patient Name: Date of Birth: Preferred Pharmacy: (name/location/phone #)

Patient Name: Date of Birth: Preferred Pharmacy: (name/location/phone #) Patient Name: Date of Birth: Referring Doctor: Primary Care Dr: Preferred Pharmacy: (name/location/phone #) CURRENT MEDICATIONS: Please list all Medication Dose Frequency 1 2 3 4 5 6 7 8 9 10 11 12 13

More information

New Patient Medical History Form

New Patient Medical History Form New Patient Medical History Form Date: Name: Date of Birth: Address: City: ZIP: Home Phone #: Cell Phone #: Emergency Contact: Relationship: Emergency Contact Phone #: Primary Care Physician: Referring

More information

Medical conditions that preclude entry

Medical conditions that preclude entry Medical conditions that preclude entry If you have or have had any of the conditions listed below, it means that you do not meet the current medical standard required to enter Military Service: NB: This

More information

20 BON ESS 17 ENTIAL

20 BON ESS 17 ENTIAL 2017 This hospital plan offers rich hospital benefits with some value-added benefits. Unlimited cover up to 100% in hospital 27 PMB chronic conditions covered Network specialists paid in full in hospital

More information

City State Zip. Cell Phone. Other Phone. Gender Male Female Status Single Married Divorced Widowed. Height Weight EXERCISE Yes No Times per Week

City State Zip. Cell Phone. Other Phone. Gender Male Female Status Single Married Divorced Widowed. Height Weight EXERCISE Yes No Times per Week Patient Name (First Middle Last) Date of Birth Social Security # Address City State Zip Home Phone Work Phone Cell Phone Other Phone Email Place of Birth Occupation Retired Yes No Gender Male Female Status

More information

Primary (First) Complaint and Location

Primary (First) Complaint and Location Name: : File #: Case Type: Sex: Birth : Age: Social Security #: Address: Residence and Mailing City State Zip Code Home Phone: Mobile Phone: Email: Occupation: Employer: Work Phone: Marital Status: S M

More information

MyCare Advisor is our online suite of tools that assist Members in understanding and comparing cost, quality, and satisfaction among Providers.

MyCare Advisor is our online suite of tools that assist Members in understanding and comparing cost, quality, and satisfaction among Providers. January 2012 What is MyCare Advisor SM? Thinking about health care services in a different light is the first step to educating yourself on health care costs. Capital BlueCross is taking the second step

More information

New Patient Packet. Patient Name: DOB: Age: Address: City: State: Zip: Address: City: State: Zip: Name: Address: Phone: Fax:

New Patient Packet. Patient Name: DOB: Age: Address: City: State: Zip: Address: City: State: Zip: Name: Address: Phone: Fax: New Patient Packet Patient Name: DOB: Age: Sex: Male / Female Height: Weight: PHYSICIAN CARE Primary Care Physician: Address: City: State: Zip: Phone: Fax: Referring Physician (if different from PCP):

More information

PLAS/RECON SURGERY PATIENT HEALTH HISTORY

PLAS/RECON SURGERY PATIENT HEALTH HISTORY PLAS/RECON SURGERY PATIENT HEALTH HISTORY Chief Complaint - Please describe the problem that brings you into the office today: Allergies 1. Do you have any allergies? if so, please list To Medications?

More information

Episodes of Care Risk Adjustment

Episodes of Care Risk Adjustment Episodes of Care Risk Adjustment Episode Types Wave 1 Asthma Acute Exacerbation Perinatal Total Joint Replacement Wave 2 Acute Percutaneous Coronary Intervention COPD Acute Exacerbation Non-acute Percutaneous

More information

What do you believe is causing your most important health concern?

What do you believe is causing your most important health concern? Intake form Name Today s Date Date of Birth Address City Phone Postal Code Email Primary Health Care Provider Emergency Contact Phone Note: By providing your email address you are giving us consent to

More information

ASPEN MEDICAL SURGERY REGINA

ASPEN MEDICAL SURGERY REGINA It is hereby certified that ASPEN MEDICAL SURGERY REGINA Has successfully completed an inspection as is required under the College s Bylaw 26.1 and is therefore approved as a Non Hospital Treatment Facility

More information

Syncope and Seizure Questionnaire

Syncope and Seizure Questionnaire Syncope and Seizure Questionnaire World College of Neurology 2/79 Wheatley Drive Bull Creek WA 6149 T 08 93320488 F 08 93329988 Copyright 2011. All rights reserved. Patient Name: MAIN PROBLEM I am here

More information

Service Bundle 1 Appendectomy - Outpatient 2 Asthma 3 Back Pain - Lumbar Diskectomy 4 Back Pain - Lumbar Fusion 5 Back Pain - Lumbar Laminectomy 6

Service Bundle 1 Appendectomy - Outpatient 2 Asthma 3 Back Pain - Lumbar Diskectomy 4 Back Pain - Lumbar Fusion 5 Back Pain - Lumbar Laminectomy 6 1 Appendectomy - Outpatient 2 Asthma 3 Back Pain - Lumbar Diskectomy 4 Back Pain - Lumbar Fusion 5 Back Pain - Lumbar Laminectomy 6 Birth Control - Cut and Tie Tubes 7 Bladder Exam - Cystoscopy 8 Bunion

More information

AXA MANSARD PERSONAL GOLD PLAN Cover & Exclusions

AXA MANSARD PERSONAL GOLD PLAN Cover & Exclusions This plan covers the following services; AXA MANSARD PERSONAL GOLD PLAN Cover & Exclusions EMERGENCY CARE: Initial stabilization and care, it also covers intensive care if required INTENSIVE CARE (covered

More information

BMI SARUM ROAD HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare*

BMI SARUM ROAD HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* BMI SARUM ROAD HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* Consultant care 99.3% satisfaction** At BMI Healthcare, we have over 59 hospitals and healthcare

More information

Patient Interview Form

Patient Interview Form Page 1 of 5 Telephone: 703-698-8960 Fax: 703-828-0961 www.novagi.com Patient Interview Form Patient Information First Name: Date Of Birth: Last Name: Race Select one or more White Unknown Black or African

More information

Prior Authorization List Effective February 2, 2015

Prior Authorization List Effective February 2, 2015 Prior Authorization List Effective February 2, 2015 Prior authorization is required for the following services. Prior authorization is the responsibility of the provider ordering or rendering services

More information

Jan 30, Dear Provider:

Jan 30, Dear Provider: Jan 30, 2015 Dear Provider: Kern Health Systems strives to provide quality and timely services to our members. Recently, KHS made changes to the services included on Prior Authorization Needed list. The

More information

CONSULTANTS DIRECTORY

CONSULTANTS DIRECTORY Specialists in Joint Replacement, Spinal Surgery, Orthopaedics and Sport Injuries CONSULTANTS DIRECTORY SEPTEMBER 2015 www. ORTHOPAEDIC SURGEONS Owen Brady Hip and knee replacement, knee surgery, soft

More information

VAPI, GUJARAT, INDIA. Redefining Quality Healthcare Globally

VAPI, GUJARAT, INDIA. Redefining Quality Healthcare Globally VAPI, GUJARAT, INDIA. Redefining Quality Healthcare Globally Haria L.G. Rotary Hospital (Managed by Rotary Charitable Trust, Vapi) Haria L.G. Rotary Hospital is a 40 years old institution and has established

More information

Luton and Dunstable Hospital ERS Services

Luton and Dunstable Hospital ERS Services Please see below the current list of all L&D services available for booking on the ESR/C&B system. This list can be downloaded by visiting the www.ldh.nhs.uk/gps-professionals/gp-admin-updates/ page of

More information

Jurong Medical Centre

Jurong Medical Centre Jurong Medical Centre JurongHealth, the public healthcare cluster formed to facilitate the integration of services and care processes for the community in the west, manages the integrated healthcare hub

More information

Mercy MS Center New Patient Information

Mercy MS Center New Patient Information Mercy MS Center New Patient Information Last Name: First Name: DOB: MULTIPLE SCLEROSIS HISTORY Reason for clinic visit: I have been diagnosed with MS or NMO (Date diagnosed ) I have not been diagnosed

More information

Surgical Workload, Outcome and Research Database: V1.1

Surgical Workload, Outcome and Research Database: V1.1 Technical Guidance for Surgical Workload, Outcome and Research Database: V1.1 Contents 1. Standard Indicators... 5 1.1. Activity Volume... 5 1.2. Average Length of Stay (Days)... 5 1.3. 2/7/30 day Re-admission

More information

SPECIALTY CPT CODES DESCRIPTION

SPECIALTY CPT CODES DESCRIPTION Primary Care Physicians: Internal Medicine, Family Practice, Pediatrics 71010, 71020, 71021, 71022, 71030, 71100, 71101, 71110, 72010, 72020, 72040, 72050, 72052, 72070, 72080, 72100, 72110, 72114, 72170,

More information

Patient Name: Date of Birth:

Patient Name: Date of Birth: Patient Name: Date of Birth: Marital Status: Single Married Divorced Widowed Height: Referring Doctor: Weight: Primary Care Dr.: Preferred Pharmacy:(name/address) ALLERGIES: Do you have any drug allergies?

More information

Review of Systems NAME: DATE OF BIRTH: DATE COMPLETED: Dear Patient,

Review of Systems NAME: DATE OF BIRTH: DATE COMPLETED: Dear Patient, LOS ANGELES CANCER NETWORK NEW PATIENT HEALTH QUESTIONNAIRE NAME: DATE OF BIRTH: DATE COMPLETED: Dear Patient, In order to offer optimal care for you, we need to understand your complete health status

More information

E-journals Suscribed Under HELINET Consoritum for the Year Dental Faculty. Sl.No. Title Publisher Access Point

E-journals Suscribed Under HELINET Consoritum for the Year Dental Faculty. Sl.No. Title Publisher Access Point 1 American Journal of Orthodontics and Dentofacial Orthopedics Elsevier Science Science Direct 2 Anaesthesia and Analgesia Wilkins Wolter Kluwver 3 Archives of Oral Biology Elsevier Science Science Direct

More information

VASCULAR SURGERY PATIENT HEALTH HISTORY

VASCULAR SURGERY PATIENT HEALTH HISTORY VASCULAR SURGERY PATIENT HEALTH HISTORY Chief Complaint - Please describe the problem that brings you into the office today: Allergies 1. Do you have any allergies? if so, please list To Medications? To

More information

Patient Interview Form

Patient Interview Form Page 1 of 5 Orange Coast Memorial Office: 18111 Brookhurst Ave. Suite 5200, Fountain Valley, CA 92708 * Tel: (714) 962-7705 * Fax: (714) 861-4552 www.unitedgi.com Patient Interview Form Patient Information

More information

In your own words, please write the reason you are here. Please be specific, putting in dates as necessary. Use the back of the form if needed.

In your own words, please write the reason you are here. Please be specific, putting in dates as necessary. Use the back of the form if needed. Name: SS# In your own words, please write the reason you are here. Please be specific, putting in dates as necessary. Use the back of the form if needed. Patient Medical, Surgical and Family History Review

More information

BMI THE BEARDWOOD HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare*

BMI THE BEARDWOOD HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* BMI THE BEARDWOOD HOSPITAL is part of BMI Hehcare, the UK s largest provider of independent hehcare* Consultant care 98.3% satisfaction** At BMI Hehcare, we have over 59 hospitals and hehcare facilities

More information

Sonoma Skin Dermatology - 1 Appointment Date: 3/19/2013 Name: Nickname: DOB: Age: Gender: Female Male Marital Status: S M D W O

Sonoma Skin Dermatology - 1 Appointment Date: 3/19/2013 Name: Nickname: DOB: Age: Gender: Female Male Marital Status: S M D W O Sonoma Skin Dermatology - Appointment Date: /9/0 Nickname: DOB: Age: Gender: Female Male Marital Status: S M D W O Spouse/Partner s SSN: DL# State: Home #: Work #: Cell Phone #: E-mail Address: Preferred

More information

Here is the list of journals reviewed by eclips Consult:

Here is the list of journals reviewed by eclips Consult: Here is the list of journals reviewed by eclips Consult: A Academic Emergency Medicine Acta Anaesthesiologica Scandinavica Acta Obstetricia et Gynecologica Scandinavica Acta Ophthalmologica Acta Orthopaedica

More information

Arkansas State Specific UM Statistics for Prior Authorizations

Arkansas State Specific UM Statistics for Prior Authorizations Arkansas State Specific UM Statistics for Prior Authorizations 2016 2017 Quarter One Quarter Two Quarter Three Quarter Four 2018 Quarter One Quarter Two Quarter Three Quarter Four 2016 Number of Prior

More information

On a scale of 1 10 ("10" being optimal health) please rate where you feel your health is in the the areas below:

On a scale of 1 10 (10 being optimal health) please rate where you feel your health is in the the areas below: Healthcare History djp Pure-Health wellness centre www.pure-health.com Wellness Profile General Health On a scale of 1 10 ("10" being optimal health) please rate where you feel your health is in the the

More information

Hybrid Open Access Journals

Hybrid Open Access Journals Wolters Kluwer Health (Medical Research) Limited List of LWW Hybrid and Gold Open Access Journals* Hybrid Open Access Journals Academic Medicine Addictive Disorders & Their Treatment Advanced Emergency

More information

Patient Interview Form

Patient Interview Form Page 1 of 5 Patient Interview Form Patient Information First Name: MRN: Last Name: Date Of Birth: Contact Preference Email Telephone call- Work Telephone call - Home Email Please check one as your preferred

More information

Diagnostic imaging suite (xray, ultrasound and. mammography) Access to CT and MRI scanning via the NHS partnership hospital.

Diagnostic imaging suite (xray, ultrasound and. mammography) Access to CT and MRI scanning via the NHS partnership hospital. BMI THE SOUTH CHESHIRE PRIVATE HOSPITAL is part of BMI Healthcare, the UK s largest provider of independent healthcare* Consultant care 98.7% satisfaction** Nursing care At BMI Healthcare, we have over

More information

Selected tables standardised to Segi population

Selected tables standardised to Segi population Selected tables standardised to Segi population LIST OF TABLES Table 4.2S: Selected causes of death, all-ages, 2000 2004 (Segi Standard) Table 5.3S: Public hospitalisations by major cause of admission

More information

Interventional Pain Medicine. P. Tennent Slack, M.D. Dr. Greg Jackson, M.D. Ben Fleming, PA-C

Interventional Pain Medicine. P. Tennent Slack, M.D. Dr. Greg Jackson, M.D. Ben Fleming, PA-C Interventional Pain Medicine P. Tennent Slack, M.D. Dr. Greg Jackson, M.D. Ben Fleming, PA-C Gainesville Braselton Medical Park 1, Suite 300 Medical Plaza B, Suite 402 1315 Jesse Jewell Parkway 1404 River

More information

PATIENT INFORMATION FORM (WOMEN ONLY)

PATIENT INFORMATION FORM (WOMEN ONLY) PATIENT INFORMATION FORM (WOMEN ONLY) Name: Age: Sex: Birthdate: / / SS # A. Describe briefly your present symptom(s) or the reason(s) for seeing the doctor today: B. Name all illnesses or conditions for

More information

Past Medical History: Medical problems pertaining only to you:

Past Medical History: Medical problems pertaining only to you: Instructions: Place an X in boxes that apply to you. Make no marks in boxes that do not apply to you. Complete all sections Past : Medical problems pertaining only to you: Cardiac / Heart I have no history

More information

New Adult Intake Form

New Adult Intake Form New Adult Intake Form Please complete the following form in order to provide us with the background information we require to ensure you receive comprehensive care. Name: Today s Date: Age: Date of Birth

More information

Preventative care: HIV test & flu vaccine Mammogram Pap smear Pneumococcal vaccine. Prostate screening

Preventative care: HIV test & flu vaccine Mammogram Pap smear Pneumococcal vaccine. Prostate screening What you get This traditional option uses a quality provider network to offer simple day-to-day benefits and hospital cover. 15% Cheaper than the PRIMARY OPTION R Day-to-day benefits and GP nomination

More information

Preventative care: HIV test & flu vaccine Mammogram Pap smear Pneumococcal vaccine. Prostate screening

Preventative care: HIV test & flu vaccine Mammogram Pap smear Pneumococcal vaccine. Prostate screening This income based entry-level plan offers basic day-to-day benefits and hospital cover using a network of doctors, providers and hospitals. What you get Basic day-to-day benefits and GP consultations with

More information

New Patient Questionnaire. Name DOB Date

New Patient Questionnaire. Name DOB Date Medical History (This refers to medical problems that have already been diagnosed or treated. Please explain how this is treated, such as diet, medication, surgery, etc.) Condition Abnormal Pap smear Alcohol

More information

CASE HISTORY. Address: City: State: Zip: Date of Birth: Age: address: Occupation: Employer: Spouse's Employer: Referred by:

CASE HISTORY. Address: City: State: Zip: Date of Birth: Age:  address: Occupation: Employer: Spouse's Employer: Referred by: CASE HISTORY Account #: Please complete this form using your keyboard, then print it using the print function of your browser. You can then sign the form and bring it with you to your first appointment.

More information

CENTRAL COAST ORTHOPEDIC MEDICAL GROUP Medical History Questionnaire GENERAL INFORMATION

CENTRAL COAST ORTHOPEDIC MEDICAL GROUP Medical History Questionnaire GENERAL INFORMATION GENERAL INFORMATION Last Name: First Name: What name do you prefer to be called? Age: DOB: / / Height: Weight: Left or Right Handed : Right Left Marital Status: M S D W Name of spouse or significant other:

More information

J. Van Lier Ribbink, M.D., F.A.C.S. Center for Endocrine and Pancreas Surgery at Honor Health

J. Van Lier Ribbink, M.D., F.A.C.S. Center for Endocrine and Pancreas Surgery at Honor Health J. Van Lier Ribbink, M.D., F.A.C.S. Center for Endocrine and Pancreas Surgery at Honor Health Patient Clinical Information Questionnaire 1.0 Date of Questionnaire Completion; / / 2.0 Patient Data 2.1 Name:

More information

LECOM Health Ophthalmology

LECOM Health Ophthalmology Patient Name: Date of Birth: New Patient Questionnaire Your answers will be used by your healthcare provider get an accurate history of your medical conditions and ocular concerns. If you are uncomfortable

More information

SAMPLE. Osteopathy and Back pain a safe and effective approach

SAMPLE. Osteopathy and Back pain a safe and effective approach Osteopathy and Back pain a safe and effective approach Back pain will affect 8 out of 10 people at some point in their life - mild or severe, acute or chronic. Common causes of back pain include: heavy

More information

Your Orthopaedic Experience: Bones, Muscles and Joints. Getting you back into motion

Your Orthopaedic Experience: Bones, Muscles and Joints. Getting you back into motion Your Orthopaedic Experience: Bones, Muscles and Joints Getting you back into motion Taking on your aches and pains You want to enjoy all life has to offer. And it s when you re mobile and active, and your

More information

Patient Name Date of Birth MALE / FEMALE Date. Left handed or Right handed. Marital Status: Single Married Divorced Widowed Children?

Patient Name Date of Birth MALE / FEMALE Date. Left handed or Right handed. Marital Status: Single Married Divorced Widowed Children? PH NEW PATIENT HISTORY Patient Name Date of Birth MALE / FEMALE Date Occupation: Left handed or Right handed Marital Status: Single Married Divorced Widowed Children? Y or N # Previous Treating Physician:

More information

Lippincott Williams & Wilkins Archive Journal Collection

Lippincott Williams & Wilkins Archive Journal Collection Lippincott Williams & Wilkins Archive Journal Collection Academic Medicine ACSM'S Health & Fitness Journal Addictive Disorders & Their Treatment Advanced Emergency Nursing Journal Advances in Anatomic

More information

GUPTA SPORTS & SPINE CENTER

GUPTA SPORTS & SPINE CENTER GUPTA SPORTS & SPINE CENTER NEW PATIENT INFORMATION FORM -ORTHO Please print all information. Thank you for your cooperation. Patient Name: Date of Birth: _ Social Security # Address: City: _ State: Zip

More information

PHA Annual High Claims Report 2018

PHA Annual High Claims Report 2018 24 October 2018 Medical device costs, increasing complexity and growing numbers of long hospital stays for mental health problems drive high health insurance claims PHA s Annual High Claims 2018 Report

More information