Sangeetha Murthy M.D

INTERNAL MEDICINE

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Before your visit     Announcements     Self Health Survey      

 

 

 

 

 

Do you have a list of concerns you would like to talk to the doctor about?

If you are a new patient please use these forms.

 

 

 

 

 



Do you have your current medication list?
Do you need any refills?




Do you have your insurance cards and are they current?
Do you have a valid picture ID?
Do you have your copay?
Do you need any referrals?
Do you need any forms filled ?

 

 

 






 





 

  

 

 

 

 

 

Are you current with your tests?
Cholesterol for those at risk ( older than 35, diabetes, family history of heart disease, obesity)- every 6 months
Hemoglobin a1c for all diabetics ( every 3-6 months)
Liver function tests for those on cholesterol medicines
Kidney function tests for thos on blood pressure medication, and diabetics ( every 6 months)
Serum TSH  for those on thyroid medications ( every 6 months AND 6 weeks a
fter every dose change)

 

 

 

 

 

 

 

Have you  taken the Health survey   in the last 12 months?

(includes immunisations, cancer screening tests and much more and helps us

identify your complete health needs and design a personalised action plan.)