Forms & Information

Providence Medical Group wants to help ease the way of our patients by providing new patient medical forms and privacy notice information in advance of their first visit. 

Please review all of the information below and complete the necessary forms prior to any patient’s first appointment to allow for quick and easy processing.

Complete these forms: (See links below)

  • Providence Medical Group Health History Form 
  • Medical Records Transfer Form
  • Family and Friends Authorization Form

Review this information: (See links below)

  • Notice of Privacy Practice
  • Genetic Privacy Notice


Ask An Expert

Ask an expert: Considering a midwife?

Midwives have facilitated childbirth for thousands of years and are a vital part of today’s modern health care delivery system. Yet many women are surprised to learn that they can choose a certified nurse-midwife and still have their baby in a hospital – with or without epidurals and other modern comforts.

Forms Instructions

New Guidelines for Mammography Screening

Breast health experts at Providence Health & Services recognize the importance and complexity of counseling women on breast health and screening recommendations. In November 2009, the US Preventive Services Task Force issued updated guidelines for breast cancer screening. These new recommendations have been met with uneven acceptance from various foundations, professional organizations and breast health providers.

We have reviewed these new recommendations carefully and have engaged a number of concerned providers, physicians and women’s health advocates in order to gain consensus around this important issue. In general, Providence endorses the thorough, professional and evidence-based effort put forth by the USPSTF and recognizes these are difficult issues to analyze.

Family and Friends Authorization Form

Complete this form to allow family and friends to speak to the clinic and the patient's doctor on the patient's behalf. 

Genetic Privacy Notice

Please review prior to the patient's first appointment.

Medical Records Transfer Form

Complete this form to transfer personal medical records from another doctor or hospital to our office.

Notice of Privacy Practice

Please review prior to the patient's first appointment.

Well child checklist

A list of developmental questionnaires from birth to age 21. 

Well child checklist-Spanish

Una lista de los cuestionarios de desarrollo desde el nacimiento hasta los 21 años.

Proprietary Health Article

Medications that are Safe During Pregnancy

Women who are between four and 12 weeks pregnant may safely take the following over-the-counter medications. Follow all directions on the container for adult dosage and usage instructions.

Tapping into maternal instincts: Empowering women through midwifery

As a pregnant woman, you have options. You can see an obstetrician, a family medicine doctor or a midwife for pregnancy care. Sometimes, you may see a combination. So, how do you decide which choice is right for you? Lisa Chickadonz, a nurse-midwife with Providence Maternal Care Clinic, is a great source of perspective on the midwife experience. 

Recommended Resource

Healthwise Decision Point: Should I bank my baby's umbilical cord blood?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Healthwise Decision Point: Should I get pregnant when I have diabetes?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Healthwise Decision Point: Should I have an early fetal ultrasound?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Healthwise Decision Point: Should I have an epidural during childbirth?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Healthwise Decision Point: Should I Have CVS (Chorionic Villus Sampling)?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Healthwise Decision Point: Should I have the maternal serum triple or quadruple test?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Healthwise Decision Point: Should I take antidepressants while I'm pregnant?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

MyMidWife.org

The American College of Nurse-Midwives website provides information and personal stories about midwives and midwifery care available to women.

Your Guide to Breastfeeding

This easy-to-read publication from Women'sHealth.gov provides how-to information and support needed to breastfeed successfully. Expert tips and illustrations help new moms learn how to breastfeed comfortably and how to overcome common challenges.

Your Guide to Breastfeeding (Spanish)

Este folleto le proporcionará información básica para facilitarle a usted y a  su bebé el proceso de la lactancia. Usted aprenderá sobre:
  • los beneficios de la lactancia para la madre, el padre y la sociedad
  • respuestas a preguntas frecuentes sobre la lactancia
  • qué hacer para ayudar a que la lactancia tenga un buen inicio
  • por qué la lactancia materna es un asunto de salud pública y qué se está
  • haciendo para promoverla y protegerla
  • por qué debería hablar acerca de la lactancia con su médico o proveedor de servicios de salud y el pediatra de su bebé
  • dónde encontrar ayuda para la lactancia, y
  • qué preguntas acerca de la lactancia hacer durante su próxima visita al médico