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Before printing and signing the forms at the bottom of the page, please read below.
To Our Patients:
Since the days of Hippocrates five hundred years before Christ, and as required by the
Oath of Hippocrates, physicians have held secret all personal information transmitted to
them by their patients. Only on a written authorization of a patient their personal
information can be given to anyone else. This has been the practice of the medical
profession in general, and in our own medical practice, since the beginning.
Now our government has recognized that insurance companies and businesses have
abused the privacy of patients relating information they obtained on signed authorization
by the patient from the physician. Congress has brilliantly decided that the solution to this is to pass a very comprehensive and complicated law telling doctors how to do what we have been doing since the days of Hippocrates. The forms that we are asking you to sign relating to privacy, security and the HIPPA law are designed to be in compliance with that law.
We apologize for any inconvenience, frustration irritation, or confusion you may feel
about it. We feel the same way. Nonetheless, it is our obligation under the law, and we
are complying. Therefore, kindly sign the documents, and we will file them in your
records where no one will be permitted ever to view them without your signed
permission.
Very sincerely yours,
Helen Feng, M.D.
The forms
The following forms need to be printed out and completed by each new patient, in full so far as possible. Established patients should print out the forms and note any changes in your personal and family history and current medications. Bring the completed forms with you at your appointment. Keep a copy for your records.
Check-In Form (pdf)
Medical History Form (pdf)
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