Privacy Notice

The Notice of Privacy Practices describes how medical information about you may be used and disclosed, and how you can get access to this information.

Department Forms

 OnSite Medical (OSM)OSM
 [EXT1] Preparticipation Medical Evaluation Form & Emergency Treatment/Parents Consent Form 07/01/2010
 OSM-A001 Provider/Patient Communication 01/08/2014
 OSM-F001 Patient Refusal for Medical Care 08/01/2013
 OSM-F002 Employee Work Status Form 10/04/2013
 OSM-F003 Abnormal Test Result Letter 08/01/2013
 OSM-F004 Employee Counseling 08/01/2013
 OSM-F005 Unable to Reach Patient with Test Results Letter 08/01/2013
 OSM-F006 DOT Advisory 08/28/2014
 OSM-F007 In-House Lab Results 08/01/2013
 OSM-F008 PRN Employment Letter 03/06/2014
 OSM-F009 Medical Records Release 08/01/2013
 OSM-F010 Tuberculosis Screening 08/01/2013
 OSM-F011 Gossip, Morale, and Destructive Behavior Employee Acknowledgement 08/01/2013
 OSM-F012 Consent for Treatment of Minor Authorization 03/06/2014
 OSM-F013 Employee Missed Meal 08/01/2013
 OSM-F014 Onsite Drug Testing Acknowledgement 08/01/2013
 OSM-F015 Fax Cover Sheet 08/01/2013
 OSM-F016 Employee Orientation Competency Checklist 08/01/2013
 OSM-F017 Call Back Log 12/01/2013
 OSM-F018 Patient Contact 08/01/2013
 OSM-F019 Blood Pressure Log 08/01/2013
 OSM-F020 Patient Referral 08/01/2013
 OSM-F021 Patient Registration 02/24/2014
 OSM-F022 School Work Excuse 02/11/2014
 OSM-F023 Weight loss Questionnaire 08/01/2013
 OSM-F024 Patient Sign In Sheet 08/01/2013
 OSM-F025 Well Woman Questionnaire 08/01/2013
 OSM-F026 Weekly Medication Quality Control Log 08/01/2013
 OSM-F027 Blood Sugar Log 08/01/2013
 OSM-F028 DOT Medication Questionnaire 08/28/2014
 OSM-F029 Onsite Employee Evaluation 08/06/2013
 OSM-F030 Onsite Food Diary 08/08/2013
 OSM-F031 Referral Appointment Letter 08/12/2013
 OSM-F032 Medical Weight Loss Documentation 08/21/2013
 OSM-F033 Injectable Medication Log 08/22/2013
 OSM-F034 Patient Medical Records Release 08/22/2013
 OSM-F035 Procedure Consent Form 08/22/2013
 OSM-F036 Fitness Program Plan and Contract 03/06/2014
 OSM-F037 Weight Management Program Patient Contract 03/06/2014
 OSM-F038 Consent and Release for Biometric Screening 04/09/2014
 OSM-F039 Biometric Screening Results Letter 04/30/2014
 OSM-F040 DOT Advisory 06/19/2014
 OSM-F041 Employee Wellness Representative Stipend Timesheet 08/21/2014
 OSM-F042 DOT Packet Coversheet 08/28/2014
 OSM-F043 Mini Health Assessment 09/04/2014
 OSM-F044 Supplement to Exam Form – Physical Condition of Drivers 09/19/2014
 OSM-F046 Patient Information Update 09/19/2014
 OSM-F047 Advance Care Plan 10/08/2014
 OSM-G001 Managing Patient Wait Times 08/01/2013
 OSM-G002 Cleaning and Stocking Exam Rooms 08/01/2013
 OSM-G003 Missed Meal Period 08/01/2013
 OSM-G004 Medication Administration of the Pediatric Patient 08/01/2013
 OSM-G005 Medication Storage 08/01/2013
 OSM-G006 Age Specific Phlebotomy Criteria 08/01/2013
 OSM-G007 Proper Communication and Patient Interaction 08/01/2013
 OSM-G008 Consent to Treat Minors Guidelines 08/01/2013
 OSM-G009 Guidelines for Patient Calls and Messages 01/08/2014
 OSM-G010 Standard Precautions Guidelines 05/27/2014
 OSM-G011 Biometric Screening Guidelines 06/02/2014
 OSM-NOPP Notice of Privacy Practices 08/01/2013
 OSM-W001 Medication Administration 08/01/2013
 OSM-W002 Administering Subcutaneous Injections 08/01/2013
 OSM-W003 Administering Intradermal Injections 08/01/2013
 OSM-W004 Administering Intramuscular Injections 08/01/2013
 OSM-W005 Front/Desk Receptionist Work Instructions 05/27/2014
 OSM-W006 Administering Allergy Injections 08/01/2013
 OSM-W007 Proper Blood Collection 02/17/2014