In addition, you will be able to access your medical history online to review or update it. Please enter your name EXACTLY as it appears on your photo ID Patient first name. Once completed you can provide a copy to any healthcare facility you choose. The name of the surgeon who will be performing your upcoming procedureĪfter you complete your medical history online, you will be able to print out a copy of your medical history and keep it for your records. First, create a Medical Passport account so you can sign in and access or update your information at any time.A list of surgical procedures you have ever had.A list of all medications you are taking, their dosage and frequency.The names, addresses and phone numbers of your physicians.Create your account or sign in if you already. Patients can send information to their healthcare team and easily update their Medical Passport for any subsequent procedures. Filling Out the Online Formīe sure to have the following information available before you start to fill out the online form: Click Here to Create an Account or Sign In Medical Passports are secure, online patient-controlled accounts that provide medical history information. Need to contact One Medical Passport directly? Already a Passport user but need help with your username and/or password? Get help here and see 'Already Have a Passport?' at the bottom left of the page. At any time, you may stop filling out the questionnaire and return to complete the form at a more convenient time. Please fill out the questionnaire accurately and completely.
Easy to UseĬompleting your medical history online using One Medical Passport is easy, and for most patients, takes less than 30 minutes. Your information will be released only to your medical team at the Crozer Health Surgery Center and will never be released to anyone other than your medical team. One Medical Passport, which is HIPPA-compliant, uses the highest grade of Internet security available. One Medical Passport is a secure website that enables you to enter your medical history online at your convenience, but prior to your surgical procedure. To make it easy for you to start the pre-surgical assessment process, The Crozer Health Surgery Center at Brinton Lake requests that you fill out your medical history online with One Medical Passport as soon as your surgical procedure is scheduled. The Booking Form allows the facility to streamline Bookings for different procedure types. Thank you for choosing the Crozer Health Surgery Center at Brinton Lake for your surgical procedure.
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