Patient Forms

Medical History Questionnaire

The questionnaire is designed to help your doctors know your general medical history and to save you time during your initial evaluation.  Because the information is important for your health care, please fill it out carefully and completely.  This will become part of your medical record; all information is strictly confidential.  Please bring the completed medical history questionnaire with you to your first scheduled appointment.

Medical History

Genetic Risk Evaluation & Testing

PET CT Scan Patient Information

Please adhere carefully to these instructions on the day of the scan.

PET CT Scan Preparation Guide

CT Scan Preparation Guide

Authorization to Use/Disclose Protected Health Information

This authorization must be read, dated and signed by the patient or by a person authorized by law to give authorization on behalf of the patient.

Authorization to Use/Disclose Protected Health Information

Electronic Medical Record Update

Photograph Consent

Insurance and Financial Policy

As cancer specialists, we are keenly aware that modern cancer care is often very expensive. We are sensitive to this fact and will work with you to provide the most effective treatment options while keeping an eye on costs. We see all patients referred to us for care. Our goal as physicians is to provide the best medical care for all of our patients.  For more Insurance and billing information, click here.  Please print, complete and bring the assignment of benefits and financial responsibilities form with you to your next appointment.

Assignment of Benefits and Financial Responsibilities

Practice Financial Policy

Patient Bill of Rights

A Patient's Bill of Rights is a statement of the rights to which patients are entitled as recipients of medical care which articulates that patients should be provided with information, offered fair treatment, and autonomy over medical decisions. Read it here.

Notice of Privacy Practices

Compass Oncology operates in compliance with the Health Insurance Portability and Accountability Act (HIPAA). HIPAA requires an increase in security of patients’ health information.

Compass Oncology has a legal and ethical obligation to protect your personal health information. We take this obligation very seriously, and have taken numerous precautions to comply with the standards dictated by our Privacy Policy.

Effective Date: September 01, 2013

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

NOTICE OF PRIVACY PRACTICES

NOTIFICACIÓN SOBRE PRÁCTICAS DE PRIVACIDAD

GENETICS PRIVACY NOTICE

My Care Plus Patient Portal

User authorization form