Forms

patient forms

Marshall Chiropractic has all the forms you need available to download. If you complete them at home, you don’t have to wait as long to be seen by the doctor.

Click here to download the following new patient forms:

  1. Patient Confidential Information
  2. Electronic Health Records Intake Form
  3. Patient Case History
  4. Patient Informed Consent
  5. Acknowledgment of Receipt of HIPAA
  6. Low Back Disability Form
  7. Neck Disability Form

Click here to download the ABN (Medicare Patients) Form.

Get your first appointment started off quickly and easily by downloading and filling out our patient’s forms before you come in. Simply click on the links above, print them out on white paper and fill out legibly in pen, provide the requested information, and bring the forms with you when you check in. You’ll save yourself time and the hassle of trying to fill them out in the waiting room.

Read more about your first visit at Marshall Chiropractic.

patient forms

HIPPA Privacy Notice

Click here to download the HIPAA Privacy Notice form.

Background

The HIPAA Privacy Rule gives individuals a fundamental new right to be informed of the privacy practices of their health plans and of most of their health care providers, as well as to be informed of their privacy rights with respect to their personal health information. Health plans and covered health care providers are required to develop and distribute a notice that provides a clear explanation of these rights and practices. The notice is intended to focus individuals on privacy issues and concerns and to prompt them to have discussions with their health plans and healthcare providers and exercise their rights.

How the Rule Works

General Rule. The Privacy Rule provides that an individual has a right to adequate notice of how a covered entity may use and disclose protected health information about the individual, as well as his or her rights and the covered entity’s obligations with respect to that information. Most covered entities must develop and provide individuals with this notice of their privacy practices. The Privacy Rule does not require the following covered entities to develop a notice:

Content of the Notice. Covered entities are required to provide a notice in plain language that describes:

The notice must include an effective date. See 45 CFR 164.520(b) for the specific requirements for developing the content of the notice. A covered entity is required to promptly revise and distribute its notice whenever it makes material changes to any of its privacy practices. See 45 CFR 164.520(b)(3), 164.520(c)(1)(i)(C) for health plans, and 164.520(c)(2)(iv) for covered health care providers with direct treatment relationships with individuals.

Providing the Notice

Organizational Options.

Read more about your first visit at Marshall Chiropractic of Tulsa.