Forms and Privacy Information
To help streamline your care, commonly requested forms are provided below for you to complete, sign and bring to your appointment.
Some forms reference Quality Internal Medicine, which maintains the secure electronic medical record system used for patient charts and billing.
Oasis Internal Medicine shares use of the secure electronic medical record system with Quality Internal Medicine. This shared system allows Nicole P. Singh, MD and Anne Rose Eapen, MD to access your medical record when coordinating and providing care.
Because the electronic medical record, medical charts, and billing systems are maintained through Quality Internal Medicine, the HIPAA Notice of Privacy Practices and related privacy forms are issued under Quality Internal Medicine.
Oasis Internal Medicine and Quality Internal Medicine are separate medical practices that collaborate in the use of a shared medical record system to support patient care.
Patient Privacy
HIPAA Notice of Privacy Practices
Registration and Patient Consent for Use and Disclosure of Protected Health Information
These documents explain how your medical information may be used and how it is protected. Please bring this completed form to your initial visit and it will also need to be completed yearly.
Medical Records
Authorization for Release of Medical Records
This form allows us to obtain your medical records from other physicians. Please submit this completed form to your other physicians prior to your appointment so that Dr. Singh may review your medical records ahead of your visit.
Telehealth
This form provides information about virtual visits and communication through secure electronic systems. Please bring this completed form to your initial visit.