Patient Forms
Prepare at your home
What makes a successful surgery
Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice
Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente
All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos
This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
Privia Medical Group provides free language services to people whose primary language is not English, such as:
– Qualified interpreters
– Information written in other languages
Should you become ill with fever, a cold, sore throat or other illness, please notify your physician as soon as possible.
Eliminate eating or drinking anything including water after midnight on the day of your procedure unless otherwise instructed by your physician. You may brush your teeth.
Do not smoke the day of your procedure as smoking may interfere with anesthesia and frequently produces nausea during the recovery period.
You will be given instructions regarding routine medications by your physician or a staff member prior to surgery. Please follow these instructions to avoid risk of your surgery being canceled or delayed.
Confirm Details: Know your arrival time and the location of your surgery before your scheduled surgery date.
Bring Required Items:
- A government-issued photo ID
- Insurance cards
- List of medications you are currently taking.
- Please bring any medications you may need during your stay at the facility (e.g. inhaler or insulin)
Bring Medical Aids: Bring any crutches, slings, or braces provided to you at your pre-op visit.
Schedule Follow-Up: Make sure your post-op visit is scheduled for 10-14 days after your surgery.
If FMLA/short term disability paper work is needed, please email this to [email protected] prior to your surgery/leave
Prepare for Surgery: Shower on the morning of your surgery to reduce the risk of infection.
Remove cosmetic items: Please remove all nail polish, makeup, and false eyelashes. Wigs, dentures, contact lenses, and other necessary accessories can be worn until you arrive at the hospital or surgery center.
Dress Comfortably: Wear casual, loose-fitting clothing that will comfortably accommodate a bandage, cast, or dressing at the site of your procedure. Opt for low-heeled shoes.
Consider Additional Comfort Items: If you are being admitted, you may want to bring a pair of slippers and a robe.
Should you become ill with fever, a cold, sore throat or other illness, please notify your physician as soon as possible.
Eliminate eating or drinking anything including water after midnight on the day of your procedure unless otherwise instructed by your physician. You may brush your teeth.
Do not smoke the day of your procedure as smoking may interfere with anesthesia and frequently produces nausea during the recovery period.
You will be given instructions regarding routine medications by your physician or a staff member prior to surgery. Please follow these instructions to avoid risk of your surgery being canceled or delayed.
