PATIENT FORMS

Complete Packet – NEW PATIENTS

 

NEW PATIENT: Baton Rouge – O'NEAL

Single packet containing all of the patient forms.
Download PDF (2.3 MB)

NEW PATIENT: Baton Rouge – PERKINS

Single packet containing all of the patient forms.
Download PDF (2.3 MB)

NEW PATIENT: GRETNA

Single packet containing all of the patient forms.
Download PDF (2.3 MB)

NEW PATIENT: METAIRIE

Single packet containing all of the patient forms.
Download PDF (2 MB)

NEW PATIENT: New Orleans – Napoleon

Single packet containing all of the patient forms.
Download PDF (3.0 MB)

NEW PATIENT: New Orleans – North Broad

Single packet containing all of the patient forms.
Download PDF (1.9 MB)

NEW PATIENT: SLIDELL

Single packet containing all of the patient forms.
Download PDF (2.3 MB)

NEW PATIENT: WESTWEGO

Single packet containing all of the patient forms.
Download PDF (2.3 MB)

Individual forms

 

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patient information form

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Responsibility for Payment and Receipt of HIPAA Notice

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HIPAA Notice of privacy act

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Designation of personal representative

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Consent for Treatment PCP

Protected Health Information (PHI) Release Forms

You may request copies of your medical records or request that your medical records be sent to another provider by contacting Automated Filing Systems (AFS) at (225) 296-0237 or release@automatedfilingsystems.com. The authorization for Release of Protected Health Information form will need to be printed, completed, and signed by the patient. Please be sure to select the form for the specific clinic that you visit.

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GRETNA LOCATION PHI release

Authorization for the Release of Protected Health Information
Download PDF (226 KB)
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NAPOLEON LOCATION PHI release

Authorization for the Release of Protected Health Information
Download PDF (226 KB)

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North Broad LOCATION PHI release

Authorization for the Release of Protected Health Information
Download PDF (213 KB)

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O'NEAL LOCATION PHI release

Authorization for the Release of Protected Health Information 
Download PDF (226 KB)
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perkins LOCATION PHI release

Authorization for the Release of Protected Health Information 
Download PDF (226 KB)

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slidell LOCATION PHI release

Authorization for the Release of Protected Health Information 
Download PDF (226 KB)

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WESTWEGO LOCATION PHI release

Authorization for the Release of Protected Health Information 
Download PDF (226 KB)
Brad J. Ramsey, D.O. family medicine

Your source for primary care providers in Baton Rouge, Gretna, Metairie, New Orleans, Slidell and Westwego. Primary Care Plus is a healthcare clinic dedicated to patient health through continuity of care.