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1068 Main Street, Suite A, Sanford, Maine 04073

1068 Main Street, Suite A, Sanford, Maine 04073-2026

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The document outlines the privacy practices and patient rights regarding health information at Orthopaedic Physical Therapy Associates. It details the obligations of the practice to protect patient health information, the circumstances under which this information may be used or disclosed, and patients' rights to access and control their health records. Additionally, it includes a payment agreement that specifies financial responsibilities for services rendered, including insurance claims processing and conditions for work-related injuries.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Patient Information' section. Enter your name, date of birth, age, and today's date. Ensure all details are accurate for proper record-keeping.
Complete the mailing address and home address fields if they differ. Include your social security number and employer information as required.
In the 'Insurance Information' section, indicate whether your visit is work-related or accident-related. Fill in your primary and secondary insurance details accurately.
Proceed to the 'Personal & Family Medical History' section. List any medications you are currently taking along with their dosage and frequency.
Answer all questions regarding your general health and medical history thoroughly to ensure comprehensive care.
Finally, review all entered information for accuracy before signing at the bottom of the form to acknowledge receipt of privacy practices.

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2016	4.8 Satisfied (82 Votes)

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What is Sanford, Maine famous for?

Sanford is a small, pleasant city in Southern Maine, known for its historic buildings and scenic neighborhoods.

What is the crime rate in Sanford Maine?

Sanford, ME has a higher overall crime rate (42.48 per 1000 people) compared to the national average (33.37 per 1000 people), with both violent and property crime rates also exceeding national averages. Sanford, ME crime rates and safety statistics - Nextdoor Nextdoor resources sanford--me Nextdoor resources sanford--me

How far is Sanford, Maine from the beach?

Sanford Maine sits 30 miles inland from the beaches of Kennebunk and Kennebunkport in the center of prestigious York County. 2025 ULTIMATE Guide To Sanford Maine Southern Maine Coast sanford-maine Southern Maine Coast sanford-maine

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