38505 Brooten Rd,

 

Suite A, PO Box 655,

 

Pacific City, OR  97135

 

For Appointments:

 

503-965-6555

  

Fax: 503-965-6800

 ~ Summary & Instruction Sheet ~

Bayshore Family

 

Medicine

There are four parts to the Summary and Instruction Sheet.

Instructions ~ These are the specific recommendations and plans from your current office visit.  This section also includes referral information, and functions as an order for blood tests, diagnostic imaging and other tests.  This sheet contains all the information needed by the hospital, it acts as your order for these tests; take it with you to the hospital and they will make a copy and give it back to you.  This sheet is yours, so make sure you get it back.  Please be aware that there is information on this sheet by way of instructions or diagnoses that may not be relevant to the tests ordered.  If you do not want this information going to the hospital, please advise us and we will give you a different order form.

 

Diagnoses ~  The first 1-3 items are the problems/diagnoses addressed in your office visit for that day.  The remainder of the list are those conditions that you are either being treated for or are an important part of your current health picture.

 

Medications ~  All of the medications that you are taking on a long term basis are listed here.  This list is reviewed and brought up to date during every office visit; it should accurately reflect what you are taking at home.  Short term medications such as antibiotics, anti-inflammatory drugs, pain medications, etc. will not be listed here.  If this list is incorrect at any time, please advise us so that we can make the corrections.  See also Medications & Refills.

 

Follow-up ~  Your return appointment and reason for it are shown here.  When you check-out the receptionist will schedule that appointment  for you if you wish or you can call back at a later date.  Our front desk staff does not schedule appointments with other physicians or for other diagnostic tests.  These are best done by you or the nurse. These sheets can be kept in the blue folder given to you by your provider.  These summary sheets should be kept for your future reference.  

 

 

 

 

 
 

 

 

 

 

 

 

 

 

 

 

Related Topics:

Health Maintenance Program

 

Screening Tests

 

Preventive Services for Men

 

Preventive Services for Women

 

Preventive Services for Children

 

Patient Education Handouts

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