HIPAA Consent Form. Conduct normal healthcare operations such as quality assessments and physician certifications.
|
|
- Cory Lawson
- 5 years ago
- Views:
Transcription
1 HIPAA Consent Form I understand that, under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), I have certain rights to privacy regarding my protected health information. I understand that this information can and will be used to: Conduct, plan, and direct my treatment and follow-up among the multiple healthcare providers who may be involved in that treatment directly or indirectly. Obtain payment from third-party payers. Conduct normal healthcare operations such as quality assessments and physician certifications. I have been informed by you of your Notice of Privacy Practice containing a more complete description of the users and disclosures of my health information. I have been given the right to review such Notice of Privacy Practices prior to signing this consent. I understand that this organization has the right to change its Notice of Privacy Practices from time to time and that I may contact this organization at any time to obtain a copy of the current Notice of Privacy Practices. I understand that I may request in writing that you restrict how my private information is used or disclosed to carry out treatment, payment, or health care operations. I also understand you are not required to agree to my requested restrictions, but if you do agree, then you are bound to abide by such restrictions. I understand that I may revoke this consent in writing at any time, except to the extent that you have taken action relying on this consent. I give permission to the staff at Legacy Health & Wellness to discuss my account information with the following people: A copy of the Notice of Privacy Practices will be provided to you at your request Patient name: Date: Signature: Relationship to Patient: Please indicate below the methods that this office may use to contact you: You may contact me at my home telephone number Yes No You may leave a message on my home answering machine Yes No You may contact me on my cell phone Yes No You may leave a message on my cell phone voic Yes No You may contact me at my work telephone number Yes No You may leave a message on my work voic Yes No You may leave a message with another person at the home telephone number Yes No You may leave a message with a co-worker Yes No You may contact my emergency telephone number
2 and leave a message Yes No
3 Patient Information Name (First) (MI) (Last) DOB / / Address City State Zip Code Home Phone Cell Phone Is it OK if we send you messages via text? Yes No Address Would you like to be added to our newsletter database? (may opt out anytime) Yes Sex Male Female No Marital Status Single Married Divorced Widowed Occupation Employer Work Phone Preferred Pharmacy Phone Spouse Information Name DOB / / Occupation Employer Work Phone How did you find out about us? Referral from Physician Friend or Family Member Radio TV Internet Other Physician that Referred You: Name Specialty Phone Address City State Zip Primary Care Physician (if other than referring physician): Name Specialty Phone Address City State Zip In Case of Emergency, Contact Phone Relation to: _ I hereby consent to evaluation, testing, and treatment/procedures that are provided to me or the patient for whom I am responsible. This would include all providers, nurses, and interns that are affiliated with Legacy Health & Wellness. Patient Signature: Date:
4 MEDICAL HISTORY FORM Last Name: First Name: MI: Allergies: o none o yes, please list: Height: Weight: (food, medications, latex, or other substances) What are you here for today? o Vein screening o IV therapy o Laser consultation o Procedure: (please list) Which body area/areas or condition would you like treated? o Face o Nose o Under Lip o Chin o Rosacea o Neck o Chest o Forearms o Under Arms o Full arms o Hands o Back o Bikini o Lower Legs o Full Legs o Scars o Stretch Marks o Other: Please answer all of the following questions 1. Do you have ANY current or chronic medical illnesses? (Please circle below) Diabetes yes no High blood pressure yes no Heart attack yes no Heart disease yes no Heart failure yes no Atrial Fib yes no High Cholesterol yes no Stroke/mini stroke yes no Seizures yes no Gastric Ulcers yes no COPD/Asthma yes no Emphysema yes no Hepatitis yes no HIV yes no Arthritis yes no Lupus yes no Gastric Reflux yes no Kidney Disease yes no Depression yes no Fibromyalgia yes no 2. Do you have ANY current or chronic skin conditions? (Please circle below) History of vitiligo yes no Eczema yes no Melasma yes no Psoriasis yes no Allergic Dermatitis yes no Ehlers-Danlos Syndrome yes no Scleroderma yes no Skin Cancer yes no Blood Clots yes no Thyroid Disease yes no Bleeding Disorder yes no Anesthesia problems yes no Pacemaker yes no Immunosuppression yes no Photosensitive Disorders yes no Heat Urticaria yes no Cancer yes no Other: Other skin condition(s): 3. Do you smoke? o yes o no If yes, when did you quit? 4. Have you underwent any surgical procedures: o yes o no If yes, please list what surgery and when: 5. Are you currently under a doctor s care? o yes o no If so, for what reason: 6. Do you take/use ANY medications (prescriptions and non-prescriptions), vitamins, herbal or natural supplements, on a regular or daily basis? o yes o no If yes, please list below or provide a list: 7. Are there any topical products (both medical and non-medical) that you use on your skin on a regular or daily basis? o yes o no If yes, please list below or provide a list: 8. Does your family have any history of the following: o Heart Disease o Hypertension o Kidney Disease o Varicose Veins o Blood Clots o Bleeding Disorder o Aneurysm o High Cholesterol o Cancer o Stroke/Mini stroke o Diabetes o Other: MEDICAL HISTORY FORM Page 1 of 2
5 MEDICAL HISTORY, CONTINUED VEIN Consultations ONLY YES NO 1. Do you or have you ever worn compression hose? o o 2. Do you experience any pain your legs? o o If so, please describe: o aching o throbbing o cramping o heaviness o sharp o shooting o restless 3. Do you have any leg swelling? o o 4. Do you have any skin discoloration? o o 5. Do you have any current of history of any problems with ulcers? o o 6. Do you have any of the known following conditions: (Please check below) o Varicose Veins o Spider Veins o Phlebitis o Cellulitis o Chronic venous insufficiency 7. Have you had any procedures performed on your veins? (Please check below) o o o Sclerotherapy o Phlebectomy o Vein stripping o RF Ablation o EVLT Laser LASER Consultations ONLY YES NO 1. Do you take/use ANY systemic/oral steroids (e.g., prednisone, dexamethasone)? o o 2. Do you have ANY allergies to medications, foods, latex or other substances? o o Please List: 3. (For women) are you or could you be pregnant? o o 4. (For women) are menstrual periods regular, or have you o o ever been diagnosed with Polycystic Ovarian Disorder? 5. Do you have a history of herpes I or II in the area to be treated? o o 6. Do you have a history of keloid scarring or hypertrophic scar formation? o o 7. Do you have a history of light induced seizures? o o 8. Do you have any open sores or lesions? o o 9. Do you have any history of radiation therapy in the area to be treated? o o 10. In the last six (6) months, have you used any of the following: o o anticoagulants or blood-thinning medications; photosensitizing medications; or antiinflammatory or blood thinning medications? Please List product name and date last used: 11. In the last three (3) months, have you used any of the following products: glycolic acid or other alpha hydroxy or beta hydroxy acid products; exfoliating or resurfacing products or treatments? o o Please List product name and date last used: 12. Do you have or have you ever had any permanent make-up, tattoos, implants, or fillers, including, but not limited to, collagen, autologous fat, Restylane, etc.? o o If yes, please list locations on or in the body and dates: _ 13. Do you have or have you ever had any Botulinums, such as Botox or Dysport? o o If yes, please list locations on or in the body and dates: 14. Have you taken Accutane (or products containing isotretinoin) in the last 12 months? o o 15. Have you taken Tretinoin (like Retin-A, Renova ) in the last 6 months? o o 16. Have you had any unprotected sun exposure, used tanning creams (including sunless tanning lotions) or tanning beds or lamps in the last 4-6 weeks? o o Patient Signature: Date: MEDICAL HISTORY FORM Page 2 of 2
New Patient Information:
New Patient Information: Patient Name: Date of Birth: / / Age: SEX: Male or Female SS# / / Home Address: City/State: ZIP: Home # Cell # Email Address Occupation: Work # Primary Language: Ethnicity: Guarantor
More informationPatient Profile. Patient Name: Today s Date: / / Date of Birth: / / Age: Gender: Female Male. Your Contact Information
Patient Profile Patient Name: Today s Date: / / Date of Birth: / / Age: Gender: Female Male Your Contact Information Phone Number Mobile Phone Number Email Address Mailing Address: Who should we contact
More informationMarlton Psychological Services 2001A Lincoln Drive West, Marlton, NJ 08053
Marlton Psychological Services 2001A Lincoln Drive West, Marlton, NJ 08053 Robert B. Haynes, Ph.D. Scott T. Parker, Ph.D. (609) 417-7300 (856) 266-2302 Intake Form Personal Information Date: Last Name:
More informationAdult Intake Form. Last Name: First Name: M.I.: City: State: Zip code: Name of emergency contact: Relationship to you: Address:
Well CENTERED Adult Intake Form 1911 Keller Andrews Road Sanford, NC 27330 919.777.9355 www.wellcenteredcounseling.com Personal Information Today s Date: Last Name: First Name: M.I.: Age: Date of Birth:
More informationShannon Lee, LMFT. Licensed Marriage & Family Therapist MFT# Los Feliz Blvd Suite #106 Los Angeles, CA
1 Shannon Lee, LMFT Licensed Marriage & Family Therapist MFT#47482 3111 Los Feliz Blvd Suite #106 Los Angeles, CA 90039 661-208-5099 Although some questions here may seem unnecessary, they will help me
More informationMindful Therapeutic Solutions
Mindful Therapeutic Solutions Maggie Minsk, LPC, NCC, CI, CHt 152 Capcom Drive Suite 101, Wake Forest NC 27616 Cell# 919-426-2924 Adult Intake Form Personal Information Today s Date: Last Name: First Name:
More informationCarol J. Gardner, D.O. 905 Roosevelt Hwy, Suite 210 Colchester, VT New Patient Profile. First Name: MI:.Last Name:. Emergency Contact Name:
Carol J Gardner, DO 905 Roosevelt Hwy, Suite 210 Colchester, VT 05446 New Patient Profile Date: First Name: MI: Last Name: Date of Birth: Age: Sex: M F Address (street, city, zip code): Home Phone #: Cell
More informationPOLICY REGARDING LEGAL CASES AND TESTIMONY
POLICY REGARDING LEGAL CASES AND TESTIMONY JEFFERSON NEUROLOGY ASSOCIATES at The Jefferson Comprehensive Concussion Center 4050 South 26th Street, Suite 140 Philadelphia, PA 19112 Dear Patient: This statement
More informationPERSONAL HEALTH SUMMARY NAME: DOB: APPOINTMENT DATE: What do you consider to be your main health problems? PAST MEDICAL HISTORY
Metropolitan Medical Associates Honeygo Professional Center 5009 Honeygo Center Drive, Suite 216 Perry Hall, MD 21128 Telephone 410-256-5858 Fax 410-529-2431 JEFFREY COOL, M.D. LISA SPEIGHT, M.D. ASHA
More informationName: Birth Date: Weight: How long have you been at this weight: Height: Waist Size: What is the main reason you came to the doctor at this time?
KIRKPATRICK F A M I L Y C A R E 1706 Washington Way Longview, WA 98632 (360) 423-9580 Primary Care Provider: First Appointment Date: Today s Date: BACKGROUND: Name: Birth Date: Weight: How long have you
More informationWhat is the main reason why you are seeking integrative medical care? (please answer in the space provided) Name: Address: Phone:
SALUTOGENESIS QUESTIONAIRE (Please fill out the following to the best of your ability) What is the main reason why you are seeking integrative medical care? (please answer in the space provided) Personal
More informationContact Details. Date: First Name: Middle Name: Last Name: Date of Birth: / / Age: Country of Birth: Address: Street Number and Name
Contact Details Date: First Name: Middle Name: Last Name: Gender: Male Female Date of Birth: / / Age: Country of Birth: Address: Street Number and Name Suburb State Postcode Country Phone: Home: Work:
More informationADULT INTAKE FORM Dr. Kimberly Dawdy, B.A. (HONS), N.D Sunset Blvd. Ottawa, ON, K4P 1C5
PLEASE PRINT CLEARLY IN BLUE OR BLACK PEN Name: Date of birth: Age: (M/D/Y) Date: Sex: M F Address: Email: Phone number: Home: Work: Mobile: May we leave messages relating to your visits? Y / N If so which
More informationPatient Encounter Structure
Checking Doorway Information Full Name Age Sex Chief Complaint Vital Signs Blood Pressure Body Temperature Respiratory Rate Heart Rate Patient Encounter Structure 1. Greeting & Introduction 2. Chief Complaint
More informationHealth Questionnaire
Health Questionnaire If you do not ask the right questions you do not get the right answers. A question asked in the right way often points to its own answer. Asking questions is the A-B-C of diagnosis.
More informationTinnitus Case History Form
Tinnitus Case History Form Patient Name: Date of Completion: Date of Birth: Gender (circle one): Male Female Current Tinnitus Where do you perceive your tinnitus: (check one) Right ear Left ear Both ears
More informationAdult Initial Questionnaire
Troy Psychological Services PLLC Sarah Gates, Psy.D. Adult Initial Questionnaire Please complete as fully as possible and bring it to your first session. This information will help me get to know you and
More informationAddress: City: State: Zip Code: Home Phone: ( ) Work Phone: ( ) Cell: ( ) Cell Phone Carrier: AT&T Sprint Verizon T-Mobile
In order to create a game plan for you to live life on your terms, its imperative that we get to know you on many different levels to help you overcome what is either holding you back or keeping you from
More informationSUMMER CELLO INTENSIVE APPLICATION July 16-21, 2018
SUMMER CELLO INTENSIVE APPLICATION July 16-21, 2018 The Pasadena Cello Institute began in 2017 as a comprehensive 6 day music program for young cellists. The schedule is filled with private lessons, monitored
More informationDiscipleship Bible School Application
Discipleship Bible School Application We are currently in the process of updating our applications. Please print this application, fill it out, then email it back to dbs@ywamoxford.org. If you don t have
More informationCase 3:01-cv CFD Document 30 Filed 06/04/2004 Page 1 of 13 IN THE UNITED STATES DISTRICT COURT FOR CONNECTICUT
Case 3:01-cv-02426-CFD Document 30 Filed 06/04/2004 Page 1 of 13 IN THE UNITED STATES DISTRICT COURT FOR CONNECTICUT IN RE: LATEX GLOVE PRODUCTS : LIABILITY LITIGATION : : ANDREA HOGAN : Civil Action No:
More informationTinnitus Intake Form
Tinnitus Intake Form NAME: AGE: DATE: / / REFERRED BY: DAYTIME PHONE: HOME PHONE: When did you first experience tinnitus? How long have you had tinnitus in its present form? years months Briefly describe
More informationEnglish Language Lesson two Dr. S. Fiala
Grammar Verbs and tenses Past simple (actions that took place in the past and are completed) (~ed for regular verbs, irregular verbs change) Present simple (~s/ ~es for he/ she/ it) Future (actions that
More informationGet ready 1 Talk about the pictures
Lesson A 1 Get ready 1 Talk about the pictures A What do you see? B What is happening? C What s the story? 2 SELF-STUDY SELF-STUDY 2 Listening A Listen and answer the questions 1 Who are the speakers?
More informationENGLISH 6 ESPAÑOL 31 PORTUGUÊS 57 PORTUGUÊS DO BRASIL 85
SC2008, SC2006 5 ENGLISH 6 ESPAÑOL 31 PORTUGUÊS 57 PORTUGUÊS DO BRASIL 85 SC2008, SC2006 6 ENGLISH Table of contents Introduction 7 Benefits 7 Intense Pulsed Light (IPL) technology for home use 7 Effective
More informationTranscriptions of the Spoken English on the DVD. A Tour of the Emergency Department The Initial Interview
Transcriptions of the Spoken English on the DVD Hurry Up & Wait Contents Page Page Page Page Page Page Page A Tour of the Emergency Department The Initial Interview The EKG The Physician s First Evaluation
More informationAUDIOLOGY CONSULTANTS, P.C.
Initial Tinnitus Questionnaire Patient Name: DOB: Date: Reason for today s appointment: Allergies to any medications, plastics, etc.? Current medications: Ear Health History Have you been exposed to loud
More informationREGISTRA TION
REGISTRA TION 2010-2011 Little Lamb/Eager Beaver Busy Bees/New Members: $90.00 (Includes t-shirt, sash, patches, slide, and scarf, pathfinders uniform) will need to pay extra for Existing Members: $75.00
More informationParent Need-to-Know Information
PARENT PARTICIPATION: Parent Need-to-Know Information If your young artist is cast in a JHCompany production your participation as a parent volunteer is essential. All of our cast parents are asked to
More informationEmergency Contact Name: Phone:
Name on Care Card Preferred Name Phone ( ) -- Home/Cell/Work Phone( ) -- Home/Cell/Work Email for appointment reminders/communication/newsletter: (by providing an email I consent to Parkway s use of that
More informationTinnitus, Symtoms, Causes and Treatment
Tinnitus, Symtoms, Causes and Treatment Contents Introduction...2 What Is Tinnitus & Its Causes?...5 Alternative Tinnitus Remedies...8 Conclusion...10 ~ 2 ~ Introduction Do you hear sounds that no one
More informationWelcome to the University of Arizona Clinic for Adult Hearing Disorders
Welcome to the University of Arizona Clinic for Adult Hearing Disorders We look forward to seeing you during your upcoming appointment. At that time, we will have: a comprehensive discussion about your
More informationWELCOME. PATIENT IDENTIFICATION Referred by. Name Name/Nickname I prefer to be called in this office. Address City/Zip Code
NEW CANAAN CHIROPRACTIC Bradley A. Williams, D.C., D.A.C.N.B., C.C.N. 45 Grove Street, New Canaan, CT 06840-5419 (203) 966-9777 FAX (203) 966-0778 Email: info@newcanaanchiropractic.com Website: www.newcanaanchiropractic.com
More informationAUDITIONS RAW MYSTERY FLAVOR
AUDITIONS RAW MYSTERY FLAVOR Directed by Erin Petersen BIGGER, BOLDER, FASTER... It s JCompany s RAW Series! JCompany Youth Theatre s RAW Series celebrates exciting works of theatre in a dynamic way. Designed
More informationPeripheral Artery Disease: Underdiagnosed and Undertreated Health Radio August 20, 2007 Paramjit Chopra, M.D. Donald Norwacki.
Peripheral Artery Disease: Underdiagnosed and Undertreated Health Radio August 20, 2007 Paramjit Chopra, M.D. Donald Norwacki Please remember the opinions expressed on Patient Power are not necessarily
More informationCheck No. Name: Chief complaint:
Check No. Name: Chief complaint: 1 I have chest discomfort/ congestion. 2 I have a heart palpitation. 3 I have pain between the nipples if I press with my finger. 4 I usually have difficulty breathing.
More informationAll of the following notes are included in our package:
(We are formerly known as BestFakeDoctorNotes.com) All of our notes: Work in all states and can be customized to any location. Can be set up with our Call Back Verification. Are modeled after real notes.
More informationKing s Kids Pathfinder Club
King s Kids Pathfinder Club Merrimack Valley Seventh-Day Adventist Church 408 Broadway Road, Dracut, MA 01826 978.804.9226 www.mvsda.org pathfinders@mvsda.org Dear Pathfinder Parent/Guardians, We are looking
More informationThe Wizardry of Roz FUNsulting, etc. s Newsletter A newsletter for people who want to add more humor into healthcare.
The Wizardry of Roz FUNsulting, etc. s Newsletter A newsletter for people who want to add more humor into healthcare. June 2009 Vol 3 No 2 WELCOME TO FUNsulting, etc. s Newsletter FUNsulting, etc. s Newsletter
More informationTinnitus can be helped. Let us help you.
What a relief. Tinnitus can be helped. Let us help you. What is tinnitus? Around 250 million people worldwide suffer Tinnitus is the perception of sounds or noise within the ears with no external sound
More informationPerformance Information Band & Honors Solo Vocal
Performance Information Band & Honors Solo Vocal Student s name Current Grade (as of May 18) Instrument/Voice Type Jazz Ensemble instrument (Band Camps only) School Name School Band/Choir Director Years
More informationApplication Instructions Please make sure to follow all instructions
The 20 th Annual Donald A. Dake Summer Music Academies Middle School Academy: June 19-22, 2017 9:00 a.m.-noon High School Academy: June 19-23, 2017 1:00-8:00 p.m. Location: Indiana University South Bend
More informationSafety Warning and Cautions
Safety Warning and Cautions 1. Do not use this device if you have a cardiac pacemaker, implanted defibrillator, or other implanted metallic or electronic device. Such use could cause electric shock, burns,
More informationPREDICTING THE IMPACT OF CELEBRITY ENDORSEMENT. Copyright Phoenix Marketing International All rights reserved
PREDICTING THE IMPACT OF CELEBRITY ENDORSEMENT 1 HOW EFFECTIVE ARE CELEBRITY ENDORSEMENTS IN PHARMACEUTICAL MARKETING? 2 THE FACT IS THAT: Consumers pay more attention to an ad with a celebrity in it AWARENESS
More informationTOP TENS. (DT6030) Instruction Manual. Please keep this instruction manual safe for future use.
TOP TENS (DT6030) Instruction Manual Please keep this instruction manual safe for future use. TABLE OF CONTENTS INDICATIONS AND CONTRAINDICATIONS... 1 WARNINGS AND PRECAUTIONS.... 2 PACKAGE CONTENTS....
More informationSue Shuttleworth Music Therapy Clinic
Dear : Sue Shuttleworth Music Therapy Clinic Thank you for your interest in the Sue Shuttleworth Music Therapy Clinic at Slippery Rock University of Pennsylvania. We are grateful to have your support in
More informationESL Podcast 435 Describing Aches and Pains. funny oddly; in an unusual way; weirdly * She talked funny after her appointment at the dentist s office.
GLOSSARY funny oddly; in an unusual way; weirdly * She talked funny after her appointment at the dentist s office. to pull a muscle to hurt the part of one s body that connects bones together and allows
More informationBeckRidge Productions Koppernick Road Canton, MI Village Theater at Cherry Hill Cherry Hill Road Canton, MI 48188
2018 Canton Idol All Auditions and Rehearsals will take place at: BeckRidge Productions 40525 Koppernick Road Canton, MI 48187 Dress Rehearsal and Performances will take place at: Village Theater at Cherry
More informationThe items listed below are the forms and materials we expect to be turnedin
FAITH WEST ACADEMY FINE ARTS DEPARTMENT PRESENTS AUDITION PACKET The items listed below are the forms and materials we expect to be turnedin before the audition. You will not be able to audition if you
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Adhesiolysis in revisional bariatric surgery, 1355 Adjustable gastric banding (AGB) complications of, 1249 1264 early postoperative, 1250
More informationAPPLICATION FOR ADMISSION
APPLICATION FOR ADMISSION Name: Age: First Middle Last Have you ever applied to or lived at Next Step Recovery? When? Permanent Address: Street: City: State: Zip Code: Social Security #: DOB: Birthplace:
More informationDOCTORS A PT E R 2. Picture Story. Asking Questions. Describing Symptoms. What is happening in these pictures?
DOCTORS Picture Story What is happening in these pictures? CH A PT E R 2 Asking Questions Describing Symptoms What is the doctor asking the patient? What body part is the patient pointing to? What is the
More informationReference ID:
1414 1415 Medication Guide 1416 PAXIL (PAX-il) 1417 (paroxetine hydrochloride) 1418 Tablets and Oral Suspension 1419 1420 Read the Medication Guide that comes with PAXIL before you start taking it and
More informationPreface. system has put emphasis on neuroscience, both in studies and in the treatment of tinnitus.
Tinnitus (ringing in the ears) has many forms, and the severity of tinnitus ranges widely from being a slight nuisance to affecting a person s daily life. How loud the tinnitus is perceived does not directly
More informationCompany Member s Signature: Parent/Guardian Signature of a Minor: PHOTO RELEASE
Woodland Theatre Productions RELEASE OF LIABILITY AND PHOTO RELEASE FORM RELEASE OF LIABILITY Woodland Theatre Productions does it s upmost to ensure that health and safety of its participants. Parents
More informationTREATMENT OF TINNITUS
TREATMENT OF TINNITUS Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs
More informationPage 1 of Community Health Needs Assessment Electronic Survey. What is the five digit zip code where you currently live?
2019 Community Health Needs Assessment Electronic Survey What is the five digit zip code where you currently live? In your opinion, how would you rate the health of your community? o Excellent (1) o Very
More informationMRI Training for Scanning at the VA
MRI Training for Scanning at the VA Acquiring permission to scan is straightforward at the VA Boston Neuro- Imaging Center and requires careful following through a series of steps listed below. No one
More informationConsulting Service: Webinar Series Music in Medicine: Enhancing the Healing Environment
Consulting Service: Webinar Series Music in Medicine: Enhancing the Healing Environment Presented by Cathy DeWitt and Ronna Kaplan 6.23.2010 The Society is grateful to the National Endowment of the Arts
More informationTinnitus stakeholder scoping workshop: notes from breakout group discussions Date: 31/10/17
Groups that will be covered Adults (18 and older), young people and children with suspected or confirmed tinnitus. No specific subgroups of people have been identified as needing specific consideration.
More informationLe Moyne College Summer Arts Institute 2017 Application
Le Moyne College Summer Arts Institute 2017 Application Student s Name: male female Date of Birth (mo/day/year) Grade completed June 2017 School attended District Home Address City/State/Zip Home Telephone
More informationUNDERSTANDING TINNITUS AND TINNITUS TREATMENTS
UNDERSTANDING TINNITUS AND TINNITUS TREATMENTS What is Tinnitus? Tinnitus is a hearing condition often described as a chronic ringing, hissing or buzzing in the ears. In almost all cases this is a subjective
More informationProduct Safety Summary Sheet
Product Safety Summary Sheet Creosote Coal tar creosote is produced by the distillation of coal tar. A byproduct of the steelmaking process, coal tar is distilled to make pitch for the aluminum industry,
More informationPROGRAMMING GUIDE. Accurate Targeting. Precise Control.
PROGRAMMING GUIDE Accurate Targeting. Precise Control. TABLE OF CONTENTS OVERVIEW Overview... 3 Linking a Remote Control to a Stimulator... 4 De-linking a Remote Control from a Stimulator... 4 Setting
More informationDONORPROFILE FACTS: LAWRENCE LAWRENCE
DONORPROFILE I don t know you, and maybe I never will. Nevertheless, I really hope I can help and be an important part of your life... FACTS: ID-release Height: 182 Weight: 80 Hair colour: Blond Eye colour:
More informationJEE 4980 Senior Design
WASHINGTON UNIVERSITY JEE 498 Senior Design Ultrasound Elasticity Imaging Final Report Steven Goodwin Mark Green 12/16/28 ABSTRACT Within this report, we have developed a useful way of retrieving a strain
More informationMusic Therapy An Alternative Medicine. Keith Brown. Northern Illinois University
Running Head: Music Therapy An Alternative Medicine 1 Music Therapy An Alternative Medicine Keith Brown Northern Illinois University 2 Today is any old regular day. You go down to the local drug store
More informationMini Electronic Pulse Massager
Mini Electronic Pulse Massager UC-029 Operating Manual Contents Introduction...2 Safety warnings....3 Part identification 4 Operating instructions...5 Program schematics....6-8 Recommended use points......8
More informationCHAUHAN VIBRATIONAL PATTERN OF THE SOURCE
by Dinesh CHAUHAN VIBRATIONAL PATTERN OF THE SOURCE In order to search for the exact vibrational pattern of a substance from the universe, we need to know the specific, individualizing and qualifying vibrational
More informationHEARING SOLUTIONS JAN 2013 MONTHLY MEETING TINNITUS PRESENTED BY DR KUPPERMAN
HEARING SOLUTIONS JAN 2013 MONTHLY MEETING TINNITUS PRESENTED BY DR KUPPERMAN Before recently moving to Sun City and becoming a valuable asset to the Hearing Solutions SIG Dr. Kupperman, known as Jerry
More informationSunday - July 31, 2016
2016 Hofstra Wrestling / LIWA Ken Lesser Memorial Summer Heat Folkstyle Tournament Sunday - July 31, 2016 Location: Divisions: Eligibility: Registration & Cost: Hofstra University David S Mack Arena Hempstead,
More informationThe HSF Summer Conservatory is designed to give high school students:
The Houston Shakespeare Festival Summer Conservatory is a two and a half week workshop of concentrated instruction in acting, voice and movement. This exciting intensive study will culminate in performances
More informationDUB SkinScanner. in medicine and cosmetic. high frequency ultrasound since 1978
DUB SkinScanner in medicine and cosmetic www.skinscanner.de DUB cutis high frequency ultrasound since 1978 taberna pro medicum GmbH High Frequency & High Resolution Ultrasound of the Skin The DUB SkinScanner
More informationThe Xavier Theatre Academy
The Xavier Theatre Academy A Program of the Saint Francis Xavier Catholic School System Presented by the Xavier Theatre Club & Christmas Stars With support from and the Thomas Feavel and Marge Bekkers
More informationLaughter, A Great Medicine Presenting The Evidence. Dr Michael Abrahams
Presenting The Evidence Dr Michael Abrahams Laughter! A physical reaction in humans and some other species of primate, consisting typically of rhythmical, often audible contractions of the diaphragm and
More informationASSEMBLY, No STATE OF NEW JERSEY. 216th LEGISLATURE INTRODUCED MAY 7, 2015
ASSEMBLY, No. STATE OF NEW JERSEY th LEGISLATURE INTRODUCED MAY, 0 Sponsored by: Assemblyman BOB ANDRZEJCZAK District (Atlantic, Cape May and Cumberland) Assemblyman GORDON M. JOHNSON District (Bergen)
More informationINTERMEDIATE PLUS UNIT 9 (B3)
Total duration: 01:32:29 INTERMEDIATE PLUS UNIT 9 (B3) Activity group(s): 1 Number of exercises: 143 Intermediate Plus Unit 9 (16 activity (ies) 01:32:29) Keywords [22 word(s)] antibiotic appendicitis
More informationCOPING WITH STRESS FOR HEALTH AND WELLNESS THE UNIVERSITY OF PITTSBURGH MEDICAL CENTER HEALTHY LIFESTYLE PROGRAM. Bruce S. Rabin, M.D., Ph.D.
COPING WITH STRESS FOR HEALTH AND WELLNESS THE UNIVERSITY OF PITTSBURGH MEDICAL CENTER HEALTHY LIFESTYLE PROGRAM Bruce S. Rabin, M.D., Ph.D. E-mail: hlp@upmc.edu Web site: http://healthylifestyle.upmc.com
More informationWhat s the matter? WORD POWER Parts of the body. A ` Listen and practice.
What s the matter? 1 WORD POWER Parts of the body A ` Listen and practice. head eye ear nose mouth tooth/teeth chin back shoulder chest stomach throat neck wrist arm elbow thumb hand finger(s) leg knee
More informationShield TENS/EMS Combination Unit Class IV
Shield TENS/EMS Combination Unit Class IV User Manual A BrownCastle Product Adrian, Pennsylvania 16210 Contact us at: Support@BrownCastle.us Visit us at: www.browncastle.us Thank You for Choosing Shield!
More informationPEER REVIEW HISTORY ARTICLE DETAILS TITLE (PROVISIONAL)
PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf)
More informationHow To Stop Ringing In Ears And Tinnitus For Good
How To Stop Ringing In Ears And Tinnitus For Good 326 Effective Tips To Cure And Get Relief Of Tinnitus By Dr. Adam Colton Published by Bizmove Free Health Books Copyright by Liraz Publishing. All rights
More informationWed. June 20th 2pm 4pm SR 208, #6 Monroe, NY OPEN TO THE PUBLIC AND HEALTHCARE PROFESSIONALS FREE PLEASE RSVP AS SPACE IS LIMITED
WHAT IT IS & HOW TO TREAT IT Tinnitus that annoying noise in your ears. it can be treated you do not have to suffer anymore. OPEN TO THE PUBLIC AND HEALTHCARE PROFESSIONALS FREE PLEASE RSVP AS SPACE IS
More informationThe AGBU Musical Armenia Program (MAP) Learn about an ancient musical tradition during an unforgettable summer in Yerevan
The AGBU Musical Armenia Program (MAP) Learn about an ancient musical tradition during an unforgettable summer in Yerevan Program Description While living in Yerevan, participants take master classes and
More information*Do not take any supplements. Please take any needed prescription medications.
Metabolic Testing Thank you for your interest in Metabolic Typing. This process is divided into two phases. Our testing is performed on a strict time schedule, so please be on time. If you need to cancel
More informationWELLERS INC. EMPLOYEE FORMS. 555 West Michigan Ave. Saline, Michigan Employee Emergency Line: http: wellersweddings.
WELLERS INC. EMPLOYEE FORMS 555 West Michigan Ave. Saline, Michigan 48176 Employee Emergency Line: 734-429-3667 http: wellersweddings.com WELLERS INC. Receipt & Acknowledgement Of Wellers' Inc. Employee
More informationBN-6 CHIN UP ATTACHMENT OWNER S MANUAL
BN-6 CHIN UP ATTACHMENT OWNER S MANUAL Product may vary slightly from the item pictured due to model upgrades Read all instructions carefully before using this product. Retain this owner s manual for future
More informationHeartLogix HLI Heart Monitor. Patient Instructions. To activate your monitor or for questions call
HeartLogix HLI Heart Monitor Patient Instructions To activate your monitor or for questions call 1-855-751-3131 Contents of Kit HeartLogix Monitor Case e holter Monitor Case Holster Battery Charger Patient
More informationThe Benefits of Laughter Yoga for People with Depression. Laughter is a subject that has been studying intensively. However, it is still a new area of
Francis 1 Milene Francis Laughter Yoga HLTH 1243 Delan Jensen Julie Pugmire Fall 2015 The Benefits of Laughter Yoga for People with Depression Laughter is a subject that has been studying intensively.
More informationDistributed by. CircFlow. Pulse Massager. Instruction Manual and Warranty Information FCB250H
Distributed by CircFlow TM Pulse Massager Instruction Manual and Warranty Information 1 FCB250H CONTENTS Page 2 What s in the box Page 3 Start Guide Page 4 Infrared plus Tips Page 5-6 Safety instructions
More informationBN: I ve been cognitively impairment and I thought it was called marriage.
73 - Memory Loss, Dementia and Alzheimerʼs BioBalance Podcast Dr. Kathy Maupin and Brett Newcomb Recorded on March 7, 2012 Podcast published to the internet on April 5, 2012 Published on drkathymaupin.com
More informationGrammar. 2 Complete the dialogue with the correct form of the verbs given.
Grammar 1 Complete the second sentence so it means the same as the first, using the word given. Do not change the word given. Use between two and five words. 1 If you don t do warm-up exercises, you ll
More informationReading Lines: Responses to Pain
Pass out these scenarios to read aloud some examples of how people might react to symptoms of illness and pain. (The parts are starred for each pair of volunteers.) Notice the differences in how people
More informationGuideline scope Tinnitus: assessment and management
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline scope Tinnitus: assessment and management The Department of Health and Socal Care in England has asked NICE to develop guidance on assessment
More informationA Noble Identification System for Tumors and Implementation
A Noble Identification System for Tumors and Implementation SHIEH-SHING LIN A, KING-TAN LEE B, JIA-HAU CHEN C, HEN-CHIA HSU D, a,c,d Department of Electrical Engineering St. John s University #499, Sec.
More information9-1 GCSE. Ancient World. Background and Context to your GCSE Course
9-1 GCSE www.stchistory.com Ancient World Background and Context to your GCSE Course Key individuals from the Ancient World: Hippocrates GREECE Hippocrates is known as the Father of Modern Medicine and
More informationJust the Key Points, Please
Just the Key Points, Please Karen Dodson Office of Faculty Affairs, School of Medicine Who Am I? Editorial Manager of JAMA Otolaryngology Head & Neck Surgery (American Medical Association The JAMA Network)
More informationMANUAL AND PROTOCOL BOOKLET
MANUAL AND PROTOCOL BOOKLET TABLE OF CONTENTS RENUVALASE II MANUAL Congratulations Important Disclosures and Disclaimer Important Precautions About RenuvaLaze II Entering Your Own Code Importance of Water
More informationAPPLICATION PROCEDURE SELECTION PROCESS AND ADMISSION REQUIREMENTS IMPORTANT DATES
BA (DRAMA AND THEATRE STUDIES): Application for admission 2019 APPLICATION PROCEDURE 1. Complete an Undergraduate Application for Admission to the University electronically or by hand. 2. Pay the application
More informationWelcome to WILCOX s Extended Donor Profile
Welcome to WILCOX s Extended Donor Profile WILCOX voluntarily provided the following information which will be disclosed to future parents as an aid in their selection General information and characteristics
More information