Patient Documents
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| 1. Authorization for TLFM to Release Health Care Info. |
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| 2. TLFM Adult Patient Registration |
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| 3. TLFM Young Adult/Child Registration |
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| 4. Sport Preparticipation Physical & General Exam Form |
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| 5. Advance Beneficiary Notice (ABN) |
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| 6. TLFM Adult Health Questionnaire Age 65 & Over |
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| 7. Auth. to Leave Personal Health Info by ALT means. |
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| 8. Preventative Care or Routine Exam DOC. |
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| 9. TLFM Basic History Age 18 & Over |
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| 10. DOL Physical Exam Form |
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PLLC | All Rights Reserved
