General AIM Forms
myNYP/Patient Portal Signup Directions - First page is English, second is Spanish. This can be printed with an individualized confirmation code (in both English and Spanish) via the Profile page in iNYP, which makes things much easier for patients.
Advance Directive Forms
Out of Hospital DNR - In English and Spanish. A single-purpose and easy to fill out order to ensure patient does not receive CPR at home. Consider MOSLT, below, for more robust advance care planning/do not hospitalize orders.
Clinical Referral Forms
PET Scan - Fillable PDF. Fax to number on top right of form.
Interventional Radiology - To request consultation and/or specific procedures. Fax to number on the form; for good measure, call the next day to ensure they call the patient.
Rehabilitation Medicine Forms - Includes vestibular rehab, cardiopulmonary rehab, seating and mobility clinic (formerly known as wheelchair clinic), and speech pathology. For PT or OT, please use the Allscripts order in the AIM order set. Fax to number on the form; for good measure, call the next day to ensure they call the patient.
Palliative Care Referral - For outpatients in need of palliative care services. Return via e-mail or fax, number on form.
Department of Health Letter Regarding Repeat CXR for Latent TB
When you have a patient with documented latent TB and a negative chest X-ray, there is no need to repeat a chest X-ray annually! This letter from the department of health can spare a lot of patients a lot of radiation.
Common Social Work Forms
M11q - You may fill out one or two of these!
NYS DOH Consumer Directed Personal Assistance Service (CDPAS) - For patients who want to hire their own HHA rather than using an agency.
Access-a-Ride/Paratransit Certification - Talk to Emilia Castrelos from social work if filling out one of these.