Resources for Patients

The following handouts are available to download and print. Completing necessary forms in advance and bringing them with you will help us keep your waiting time to a minimum.

All resources are available in PDF format.
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Trinity Center Resources
Policy on Advance Directives			Medical Records Individual Authorization Form
Electronic Health Information Consent Form			Medical Records Request Form
Electronic Health Information System Fact Sheet			Medical Records Release Form
Patient Demographic Form			Financial Acknowledgement Form
Financial Policies			HIPAA Form
Referral Form for Testing			Non-Participating Plans Pre-Payment Acknowledgment Form
Cardiology Resources
Stress Test Preparation Checklist
Gastroenterology Resources
Dr. Kummer's Patient Forms:		Dr. Laufer's Patient Forms:		Dr. Rajapaksa's Patient Forms:
HalfLytely® Preparation for Colonoscopy		Colonoscopy Preparation Instructions		Colonoscopy Preparation Instructions
Preparation for Upper G.I. Endoscopy		Colonoscopy: Day of Procedure		2-day Colonoscopy Preparation Instructions
Preparation for Sigmoidoscopy		MoviPrep Instructions: Morning Appointments		Colonoscopy: Day of Procedure
Colonoscopy with MoviPrep Instructions		MoviPrep Instructions: Afternoon Appointments		Colonoscopy with MoviPrep Instructions
		Extra Strength Instructions		Upper Endoscopy Instructions
		OsmoPrep Colonoscopy Procedure
		Instrucciones para MoviPrep (En Español)
Forms for Special Circumstances: Use only when directed by Dr. Kummer
PEG Preparation for Colonoscopy
Imaging Resources
Compact Disc Release Form			CT Scan: Questionnaire
Internal Medicine
Dr. Carron's Patient Forms:
Medical History Form			Sending Protected Health Information
Immigration Registration Form			Immigration Agreement
INS Form