TELEPHONE AND REMOTE FOLLOW UP VISITS

The forms necessary for these visits can be printed out, completed and faxed to (877) 411-1871 or emailed to our office at omason@attention.md.  A web form for adults is now available which allows you to fill out & submit directly online.  We need the completed form prior to the appointment time for your visit. 

If you use a different word processor, remember to save the completed form in .doc or .pdf format.  Please do not send forms in the default Mac formats.  

Please note that you will need to obtain pulse, weight and blood pressure readings prior to telephone visits.  These can be from your physician's office, a pharmacy or home equipment.

Child Follow Up Form

Parent or teacher update of progress since last visit.

(Word DOC form)   (PDF form)      

Adult Follow Up Form

This form is appropriate for patients 18 years of age and older.  Copies can be given to an observer--a spouse, partner or close friend--who can give a second perspective on progress.)

(Word DOC form)   (PDF form)    (Web form)

SHARING INFORMATION WITH PARENTS, THERAPISTS, COUNSELORS, COACHES, OTHER PHYSICIANS

This form below allows Attention MD to discuss patient care or send records.

Fill out & email to omason@attention.md or Fax to (877) 411-1871

Permission to disclose confidential information  

(PDF form)  

________________________________________________________________________________________________

CONFIDENTIALITY NOTICE: Email and text messaging systems do not meet the level of security recommended in the HIPAA legislation.  We make these forms of communication available to individuals who prefer convenience at the expense of security.  Phone and fax communications satisfy HIPAA regulations and are preferred for those who