Patient Instructions

Prior to your first visit, please print and complete the forms below and bring them with you on the day of your appointment along with your insurance cards and a photo ID.  Also, bring all medications you are taking, include all prescription drugs and any over-the-counter medications and herbal supplements. Please bring all the medical records you have that relate to this referral.

Notice of Privacy Practices

Form One

Nephrology Associates New Patient Paperwork
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This document is for your physician to know your basic information. It includes your name, your emergency contact, and who referred you.

Form Two

Authorization for Disclosure of Health Information
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This form gives authorization for the release of medical records that include your diagnosis, treatment, laboratories, and imaging studies.

Form Three

Acknowledgment of Receipt of Notice of Privacy Practices
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This notice describes how Nephrology Associates of Lake County, LLC may use and disclose your protected health information.