Printable Forms  

·        AIM Patient Info- General AIM Patient Information Brochure 

§  English                   Spanish

§  My NYP Invitation information sheet

·        Transition of Care Letter to patients

·        Letter Group A (hi risk)               English          Spanish

·        Letter Group B                               English          Spanish

·        Advance Directive Resource Page

·        Narcotic Rx Patient Informed consent “narcotic contract” - English       Spanish

·         See also Opioid Use Risk Assessment Tool (links to Opiod Risk Tool and other useful pain mgmt resources)

·        Genetic Testing Pathology Forms – consent for thrombophilia and other genetic testing

·        HIV Viral load order form

·        Medical Record Release Form

·        Pain Clinic Referral Form (clinic will not call pt- pts should know to f/u and call 305-7114 for appt)

·        PET Scan Referral form

·        Physical Therapy Form

·         Sleep Study/Clinic Referral (please tell pts to call the Sleep Center to set up appt)

·         Sleep Referral Instructions and Success Tips (QI Team J Lee/Lawton/Vullaganti Jan 2015)

·        Transportation Form (Medicaid Only) MAP 2015