FOA Orthopaedics
Contact Us: (540) 373-4602 
Fax: (540) 310-0100 
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MD & PA-C Forms
   

What All Patients Need To Know Regarding Required Medical Forms

We request that you arrive at least 30 minutes before the scheduled time of your appointment for the purpose of registration.  We also require that you present your insurance card, any previous X-rays, MRIs, or scans relating to your current condition as well as a list of any or all current medications.

We require all FOA patients to complete and sign the forms indicated below and provide to the attending physician or physician assistant during the scheduled appointment.  For security reasons as well as protection of patient privacy, we do not allow online submission of said forms.


1.  Patient Information Sheet

2.  Patient Medical History

3.  Reason For Visit

4.  HIPAA


Physical Therapy Forms
   

What all patients need to know prior to receiving initial physical therapy:

We request that you arrive at least 30 minutes before the scheduled time of your appointment for the purpose of registration.  We also require that you present your insurance card, any previous X-rays, MRIs, or scans relating to your current condition as well as a list of any or all current medications.

We require all FOA patients to complete and sign the forms indicated in 1 through 5 below and provide to our Physical Therapist during the scheduled appointment.  For security reasons as well as protection of patient privacy, we do not allow online submission of said forms.


1.  Patient Information

2.  Patient Medical History

3.  Reason For Visit

4.  HIPAA

We also require patients to choose and complete any of the applicable form(s) listed below based on the location of the injury or part of the body being treated.

A.  Upper Extremity

B.  Lower Extremity

C.  Neck

D.  Back


Medical Records and X-Ray Request Forms
   

***NEW*** We are happy to announce that patients can now receive medical records electronically through HealthPort!  In order to provide this service, our procedures and forms have changed slightly.

To receive your medical records and/or X-Rays electronically, simply print and complete the following forms:

1.  Healthport Records Request

2.  Healthport HIPAA

3.  Healthport Electronic Delivery*

4. Healthport Electronic Disclosure*

* If you would prefer to continue to receive your records by mail, you need only to complete the first two forms above (Records Request & HIPAA).

Fax all completed forms to our Medical Records Department - 540-310-0100.  Forms may also be submitted via mail or delivery in person.

If you have any questions about this process, please contact our Medical Records Department at 540-372-4225.

If would like to inquire about your records request, please contact HealthPort directly at 800-367-1500 or www.healthport.com.

 

FREDERICKSBURG ORTHOPAEDIC ASSOCIATES, P.C.
Orthopedic Physician Appointments:  (540) 372-4221  |  Physical Therapy Appointments:  (540) 479-4764
FREDERICKSBURG
3310 Fall Hill Avenue,
Fredericksburg, VA  22401
SPOTSYLVANIA
4710 Spotsylvania Parkway
Fredericksburg, VA  22407
STAFFORD
90 Greenspring Drive
Stafford, VA  22554

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