Patient Medical Records
You can stop by our office Monday-Friday to pick up the Disc between 09:00 am to 04:30 pm.
AIC Prep Instructions -
NOW OPEN 7AM – 5:30PM MON – FRI FOR ALL SERVICES BY APPOINTMENT ONLY
New Prep Instructions and Map
(File size: 626,335 bytes)
Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.
New Script Pad
AIC script 2018
(File size: 1,449,809 bytes)
Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.
New Patient Form
New Patient Form Page 1
(File size: 225,923 bytes)
Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.
PRINT ABN FOR MEDICARE POLICIES
AIC ABN
(File size: 332,226 bytes)
Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.
PRINT IF YOU HAVE ANY INSURANCE BESIDES MEDICARE
MANAGED CARE WAIVER-revised 07 2015
(File size: 64,022 bytes)
Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.
Dexa Form
DEXA FORM
(File size: 230,680 bytes)
Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.
X-Ray Form
XRAY FORM 18
(File size: 227,645 bytes)
Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.
CT/PET Form
CT Questionnaire 18
(File size: 228,314 bytes)
Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.
Auto Accident/Slip and Fall Paperwork
PIP PAPERWORK WITH MCW AND ABN
(File size: 595,801 bytes)
Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.
HIPPA (PRIVACY POLICY)
HIPAA AND AUTHORIZATION
(File size: 134,121 bytes)
Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.
MRI and Hippa
MRI and Hippa
(File size: 222,190 bytes)
Note: The request form is in PDF format and requires Adobe Acrobat Reader. If you don't have Acrobat Reader you can download it from www.adobe.com.
If you are unsure what to print, Kylie will be more than happy to assist you if you e-mail her at kbarnes@advancedimagingconcepts.com