Get Patient Instruction Packet - Kips Bay Endoscopy Center

Completing the Patient Instruction Packet for Kips Bay Endoscopy Center online is essential to ensure a smooth and efficient process for your upcoming appointment. This guide provides clear, step-by-step instructions to assist you in filling out the form accurately and thoroughly.

Follow the steps to complete your Patient Instruction Packet online.

1. Press the ‘Get Form’ button to receive the Patient Instruction Packet and open it in the online editor.
2. Begin with the Welcome Notice section, which provides important information about the center, its services, and the professionalism of its staff. Make sure to read through it carefully.
3. Fill out the Patient Registration Sheet located on page 5. Include all necessary personal information such as your name, date of birth, contact details, and insurance information. Be thorough and ensure the accuracy of all submitted data.
4. Complete the Medication List and Pre Procedure Questionnaire on page 6. List all current medications, including prescriptions and over-the-counter drugs, and indicate any allergies you have.
5. Review the Ownership Disclosure on page 7. This section informs you about potential conflicts of interest regarding the physicians involved with the Kips Bay Endoscopy Center.
6. Read and understand the Financial Policy on page 8. Sign where indicated to acknowledge you are aware of your financial responsibilities.
7. Fill out the Uniform Assignment and Release of Information Statement on page 9. This section authorizes the center to release your medical information to relevant parties for payment purposes.
8. Complete the Consent for Procedure section on pages 21-22. Please do not sign this section until you are at the center, as instructed.
9. After completing pages 5-11 and 21 & 22, save your changes and prepare to download or print the form for your appointment.
10. Finally, ensure you bring the completed forms along with your photo identification and insurance card to your scheduled appointment.

Complete your Patient Instruction Packet online today and ensure a seamless experience at Kips Bay Endoscopy Center.