Patient Forms and documents

OrthoWashington and Washington Institute Orthopedic Center provide the following alphabetical listing of printable PDF forms, documents and external links for our patients’ convenience:

A, B

About Advance Directives

Acknowledgment of Financial Responsibility for the Cost of Services

Acknowledgment of Receipt of Notice of Privacy Practices

Authorization for Biomechanical Examination and Treatment

Authorization to Release Medical Records

Automobile Accident Information

C, D, E

Common Post-Operative Medication Usage Information

Concussion Protocol and Treatment

Consent to Toenail Surgery

F

Femoral Nerve Block

Financial Agreement

Follow-Up Medical Questionnaire

Foot and Ankle Surgery Overview

Foot Discharge Instructions

G

General Discharge Instructions

H

HA Injection Questionnaire

I, J

ImPACT Post-Concussion Symptom Scale

Important Product Information

Incident Questionnaire​

Insurance Verification​

K

Knee Discharge Instructions

Knee Injection Questionnaire

L

Labor and Industries Information

LifeWise Incident Questionnaire

M

MRI Preparation and Patient Financial Responsibility

N, O

New Patient Checklist

Notice of Policy Regarding Advance Directives

Notice of Privacy Practices

P, Q

Patient Bill of Rights and Responsibilities

Patient Health History

Patient Registration

Patient Testimonial and Authorization Release

Peripheral Nerve Block Discharge Instructions

Physical Therapy Authorization Waiver

Pre-Operation Questionnaire

Post-Operation Questionnaire

Post-Operative Instructions: Arthroscopy

Post-Surgical Nail Instructions

Pre-Operation Questionnaire

Premera Blue Cross Incident Questionnaire

R

Regence BlueShield Incident Report

S

Surgery Patient Guide - EvergreenHealth Medical Center (EHMC)

Surgery Patient Guide - Washington Institute Orthopedic Center (WIOC)

Surgery Patient Satisfaction Survey

T - Z


All forms and documents are copyright ©2017-19 OrthoWashington and Washington Institute Orthopedic Center as noted.