

     <!-- SiteMaker 6.5 CMS (TM)
     Code created by Medseek, Inc. 2028 Village Lane, Solvang CA 93463.
     Phone 1-888 MEDSEEK. email info@medseek.com. http://www.medseek.com 
     (c) 1999-2006 Medseek, Inc. All rights reserved.-->
    










	

		
		
		
		
		
		
		
		
		
		
		
		
		
		

		
			
		
		 
		
		
		
		

		
		
		
		
		
		
		
		
		
		

		
		
		
		

		

		
		
		

			
				
			
		
		
		
		
		

		
		
		
		
		
		
		
			

		
		
		
		
				
		
		
		
				
		
			
		

		
		
		
		
		
		
	
		
			
			
			
		
		
		
	
		
			
			
		

		
		
		
		
			

		

		
		
		

			
				
			
		
		
		
		
		

		
		
		
		
		
		

		
					
						
		
		
				
		
		
		
		
		
				
		
		

		
		
		
		
		
		
		
		
			
			
				
			
		
		
		
		
		
			
			
		
		
		
		
		
			
			
		

		
		
		
			
			
		
		
		

		
			

			
		
		

		
		

		
				
		 
		
			
		
		
		

		
			
			
		
		
		
			

		

		
		
		
		

		
		

		
		
		
		
		
		
		
		
		
		

		
	

		
		
		
		
		
		
		
		
		
		
		
		
		
		

		
			
		
		 
		
		
		
		

		
		
		
		
		
		
		
		
		
		

		
		
		
		

		

		
		
		

			
				
			
		
		
		
		
		

		
		
		
		
		
		
		
			

		
		
		
		
				
		
		
		
				
		
			
		

		
		
		
		
		
		
	
		
			
			
			
		
		
		
	
		
			
			
		

		
		
		
		
			

		

		
		
		

			
				
			
		
		
		
		
		

		
		
		
		
		
		

		
					
						
		
		
				
		
		
		
		
		
				
		
		

		
		
		
		
		
		
		
		
			
			
				
			
		
		
		
		
		
			
			
		
		
		
		
		
			
			
		

		
		
		
			
			
		
		
		

		
			

			
		
		

		
		

		
				
		 
		
			
		
		
		

		
			
			
		
		
		
			

		

		
		
		
		

		
		

		
		
		
		
		
		
		
		
		
		

		
	

		
		
		
		
		
		
		
		
		
		
		
		
		
		

		
			
		
		 
		
		
		
		

		
		
		
		
		
		
		
		
		
		

		
		
		
		

		

		
		
		

			
				
			
		
		
		
		
		

		
		
		
		
		
		
		
			

		
		
		
		
				
		
		
		
				
		
			
		

		
		
		
		
		
		
	
		
			
			
			
		
		
		
	
		
			
			
		

		
		
		
		
			

		

		
		
		

			
				
			
		
		
		
		
		

		
		
		
		
		
		

		
					
						
		
		
				
		
		
		
		
		
				
		
		

		
		
		
		
		
		
		
		
			
			
				
			
		
		
		
		
		
			
			
		
		
		
		
		
			
			
		

		
		
		
			
			
		
		
		

		
			

			
		
		

		
		

		
				
		 
		
			
		
		
		

		
			
			
		
		
		
			

		

		
		
		
		

		
		

		
		
		
		
		
		
		
		
		
		

		
	

		
		
		
		
		
		
		
		
		
		
		
		
		
		

		
			
		
		 
		
		
		
		

		
		
		
		
		
		
		
		
		
		

		
		
		
		

		

		
		
		

			
				
			
		
		
		
		
		

		
		
		
		
		
		
		
			

		
		
		
		
				
		
		
		
				
		
			
		

		
		
		
		
		
		
	
		
			
			
			
		
		
		
	
		
			
			
		

		
		
		
		
			

		

		
		
		

			
				
			
		
		
		
		
		

		
		
		
		
		
		

		
					
						
		
		
				
		
		
		
		
		
				
		
		

		
		
		
		
		
		
		
		
			
			
				
			
		
		
		
		
		
			
			
		
		
		
		
		
			
			
		

		
		
		
			
			
		
		
		

		
			

			
		
		

		
		

		
				
		 
		
			
		
		
		

		
			
			
		
		
		
			

		

		
		
		
		

		
		

		
		
		
		
		
		
		
		
		
		

		
	

		
		
		
		
		
		
		
		
		
		
		
		
		
		

		
			
		
		 
		
		
		
		

		
		
		
		
		
		
		
		
		
		

		
		
		
		

		

		
		
		

			
				
			
		
		
		
		
		

		
		
		
		
		
		
		
			

		
		
		
		
				
		
		
		
				
		
			
		

		
		
		
		
		
		
	
		
			
			
			
		
		
		
	
		
			
			
		

		
		
		
		
			

		

		
		
		

			
				
			
		
		
		
		
		

		
		
		
		
		
		

		
					
						
		
		
				
		
		
		
		
		
				
		
		

		
		
		
		
		
		
		
		
			
			
				
			
		
		
		
		
		
			
			
		
		
		
		
		
			
			
		

		
		
		
			
			
		
		
		

		
			

			
		
		

		
		

		
				
		 
		
			
		
		
		

		
			
			
		
		
		
			

		

		
		
		
		

		
		

		
		
		
		
		
		
		
		
		
		

		
	
		
	
	
		
	
	
	
	
	
	
	
	
	
	
	<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
	<html>
	<head>
	<title>Health Forms</title>
	<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
	<meta name="description" content="">
	<meta name="keywords" content="">
	<style type="text/css">
		@import url(default.css);
		@import url("healthsystem.css");
	</style>
<script language="javascript" src="scripts/weather.js" type="text/javascript"></script>
	<script src="scripts/AC_ActiveX.js" type="text/javascript"></script> 
	<script src="scripts/AC_RunActiveContent.js" type="text/javascript"></script>
	<script src="scripts/popup.js" type="text/javascript"></script>
	<script type="text/JavaScript">
	<!--
	function MM_swapImgRestore() { //v3.0
		var i,x,a=document.MM_sr; for(i=0;a&&i<a.length&&(x=a[i])&&x.oSrc;i++) x.src=x.oSrc;
	}
	function MM_preloadImages() { //v3.0
		var d=document; if(d.images){ if(!d.MM_p) d.MM_p=new Array();
			var i,j=d.MM_p.length,a=MM_preloadImages.arguments; for(i=0; i<a.length; i++)
			if (a[i].indexOf("#")!=0){ d.MM_p[j]=new Image; d.MM_p[j++].src=a[i];}}
	}
	function MM_findObj(n, d) { //v4.01
		var p,i,x;  if(!d) d=document; if((p=n.indexOf("?"))>0&&parent.frames.length) {
			d=parent.frames[n.substring(p+1)].document; n=n.substring(0,p);}
		if(!(x=d[n])&&d.all) x=d.all[n]; for (i=0;!x&&i<d.forms.length;i++) x=d.forms[i][n];
		for(i=0;!x&&d.layers&&i<d.layers.length;i++) x=MM_findObj(n,d.layers[i].document);
		if(!x && d.getElementById) x=d.getElementById(n); return x;
	}	
	function MM_swapImage() { //v3.0
		var i,j=0,x,a=MM_swapImage.arguments; document.MM_sr=new Array; for(i=0;i<(a.length-2);i+=3)
		 if ((x=MM_findObj(a[i]))!=null){document.MM_sr[j++]=x; if(!x.oSrc) x.oSrc=x.src; x.src=a[i+2];}
	}
	//
	function addEvent(obj, evType, fn){
		if (obj.addEventListener){
			obj.addEventListener(evType, fn, false);
			return true;
		} else if (obj.attachEvent){
			var r = obj.attachEvent("on"+evType, fn);
			return r;
		} else {
			return false;
		}
	}
	function DHTMLIframeHeight(){
		var z	=	new RegExp('lryParentmain[0-9]+');
		var x	=	new RegExp('Framelyr[0-9]+');
		var h = 0;
		var	a	=	new Array();
		var	u	=	0;
		for(y = 0; w = document.getElementsByTagName("div")[y]; y++){
			try{
				if(w.id.match(z)){
					var c	=	0;
					var d = 0;
					var t = 0;
					var e	=	document.getElementById(w.id).getElementsByTagName("iframe");
					for(i	=	0; i < e.length; i++){
						if(e[i].id.match(x)){
							c++;
							u=0;
							t=0;
							a[c] = e[i].id.substring(8,(e[i].id.length));
							l = document.getElementById('lyr'+a[c]).getElementsByTagName("a");
							e[i].style.height = "0px";
							for(h=0; classname = l[h].className; h++){
								try{
									if(classname == "clSubb1"){
										d++;
										u = 0;
										u = l[h].innerHTML.length;
										u = Math.floor(u / 16);
										if(u <= 0){u = 1;}
										u = u * 23;
										t = t + u;
										e[i].style.height = t;
									}
								}
								catch(error2) {
									//
								}
							}
						}
					}
				}
			}
			catch(error) {
				//
			}
		}
	}
	if(navigator.userAgent.indexOf('MSIE 6') > 0){
		addEvent(window, 'load', DHTMLIframeHeight);
	}
	//
	//-->
</script>
<script language="javascript">
var readMoreToggle = false;
function readMoreOnClick(varRef, state)
{
	if (state == 2)
	{
		//document.getElementById("swvar_additionalinfo").innerHTML = "";
		document.getElementById("more_info"+varRef).style.display = "none";
		document.getElementById("more_info_text"+varRef).innerHTML = "<a href='javascript:void(0)' onclick='readMoreOnClick("+varRef+",1);'><span id='more_info_text"+varRef+"'>Read More</span> &raquo;</a>";
		readMoreToggle = false;
	}
	else
	{
		//document.getElementById("swvar_additionalinfo").innerHTML = document.getElementById("swvar_additionalinfo_text").value;
		document.getElementById("more_info"+varRef).style.display = "inline";
		document.getElementById("more_info_text"+varRef).innerHTML = "<a href='javascript:void(0)' onclick='readMoreOnClick("+varRef+",2);'><span id='more_info_text"+varRef+"'>Minimize</span> &raquo;</a>";
		readMoreToggle = true;
	}				
}
</script>
	
<script language="javascript" type="text/javascript">
	// Add the resize function to the page load event
	function msd_fontsizeAddEvent(obj, evType, fn){
		if (obj.addEventListener){
			obj.addEventListener(evType, fn, false);
			return true;
		} else if (obj.attachEvent){
			var r = obj.attachEvent("on"+evType, fn);
			return r;
		} else {
			return false;
		}
	}
	// Triggers a resize on page load 
	msd_fontsizeAddEvent(window, 'load', msd_fontsizeInit);
	// Initialize the page
	function msd_fontsizeInit(){
		// Compute the font sizes for all tags whose style.fontSize is undefined.
		for(var i=0; element = document.getElementsByTagName("*")[i]; i++){
			element.style.fontSize = msd_fontsizeGetCurrentFontSize(element);
		}
		 // Set the font to the last saved value (in the cookie.)
			if(msd_fontsizeGetCookie() != ""){
				msd_fontsizeIncrement(msd_fontsizeGetCookie(),true);
			} else { // Cookie doesn't exist. Create it and set the font size.
				msd_fontsizeIncrement('0',true);
				msd_fontsizeSetCookie('0');
			}
		
		
		if(document.getElementById('msd_increase')){
			if(msd_fontsizeGetCookie() == 4){
				document.getElementById('msd_increase').src='images/msd_fontsize/increase_.gif';
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		}
		if(document.getElementById('msd_decrease')){
			if(msd_fontsizeGetCookie() == -4){
				document.getElementById('msd_decrease').src='images/msd_fontsize/decrease_.gif';
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		}
	}
	// function to set the value of the cookie.
	function msd_fontsizeSetCookie(value) { 
		var name = "msd_fontsize_relative";
		
		var curCookie = name + "=" + escape(value);
		
		document.cookie = curCookie;
	}
	// function to get the cookie value.
	function msd_fontsizeGetCookie(){
		var name = "msd_fontsize_relative";
		if (document.cookie.indexOf(name) != -1) {
			cs=document.cookie.indexOf(name+"=");
			if(cs!=-1){
				cs=cs + name.length+1;
				ce=document.cookie.indexOf(";",cs);
				if(ce==-1) ce=document.cookie.length
				return parseInt(unescape(document.cookie.substring(cs,ce)));
			} else {
				return "";
			}
		} else {
			return "";
		} 
	}
	// A function to compute the current font size as rendered by the browser.
	function msd_fontsizeGetCurrentFontSize(elem){
		var ieFontScale	=	new Array ("10","11","12","14","18","24","30","36","48","60","72");
		if ( elem == null )
			return null;
		
		// if the style isn't defined inline, then ask the browser to compute the current size	
		if ( elem.style.fontSize == "")
		{
			var browserName=navigator.appName; 
			var browserVer=parseInt(navigator.appVersion); 
			if (browserName=="Microsoft Internet Explorer" && browserVer>=4) 
				//font element was deprecated in HTML 4.01
				//IE does not handle the increments well without this
				if(elem.tagName == "FONT"){
					var ieFontIndex = elem.getAttribute("size");
					if(ieFontIndex == "" || ieFontIndex < 0){
						return ieFontScale[2];
					} else {
						return ieFontScale[ieFontIndex];
					}
				} else {
					return elem.currentStyle.fontSize;
				}
			else
				if(navigator.vendor.indexOf('Apple') != 0){
					return document.defaultView.getComputedStyle(elem, '').getPropertyValue("font-size");
				} else {
					return '12';
				}
		}
		// else return the current fontsize.
		else
		{
			return elem.style.fontSize;
		} 
	}
	// Checks if an element is a child of a filtered node (one that should be resized.)
	function msd_fontsizeParentIsFiltered(elem_temp){
		var elem = elem_temp;
		var classname;
		while ( elem.parentNode != null && elem.parentNode.tagName != "HTML")
		{
			elem = elem.parentNode;
			try
			{
				if ( elem.getAttribute('class') != null )
					classname = elem.getAttribute('class');
				else
					classname = elem.className;
			
				var isResizable = classname.indexOf('content') >= 0;
			
				if (classname == "content" | isResizable)
					return true;
			} catch(err) {/*alert(elem + ": " + err.description + " ");*/}
		}
	
		return false;
	}
	// Increments the fontsize of an element.
	function msd_fontsizeIncrementElement(elem,size){
		var currentSize;
		var currentVal;
		var currentUnit;
		var unitPattern = /[A-Z]+$/i;
		
		if ( msd_fontsizeParentIsFiltered(elem) )
		{
			currentSize = msd_fontsizeGetCurrentFontSize(elem);
			currentVal = currentSize.substring(0,currentSize.search(unitPattern));
			currentUnit = currentSize.substring(currentSize.search(unitPattern),currentSize.length);
		
			if ( currentVal > 0)
				elem.style.fontSize = (size + parseFloat(currentVal)) + currentUnit;
		}
	}
	// Increments the font size of every element on the page by "size."
	// Size can be either +,-,default, or an integer value between the max and min allowed.
	// the dontUpdateCookie flag prevents the function from updating the cookie after the font resize.
	function msd_fontsizeIncrement(size,dontUpdateCookie){
		if( size == "+" )
			size = 1;	
		else if ( size == "-" )
			size = -1;
		else if ( size == "default" )
			size = -msd_fontsizeGetCookie();	
		else
			size = parseInt(size);
			
		if ( dontUpdateCookie == null )
			msd_fontsizeSetCookie( size + msd_fontsizeGetCookie() );
			
		for ( var i=0; element = document.getElementsByTagName("*")[i]; i++ )
			msd_fontsizeIncrementElement(element,size);
	}
	</script>

				
<script type="text/javascript">
//<!--
var ns4 = (document.layers);
var ie  = (document.all);
var ie4 = (ie && !document.getElementById);
var ie5 = (ie && document.getElementById);
var ns6 = (!ie && document.getElementById);

var aryMoused = new Array();
var aryLayerMoused = new Array();
var aryMoImages = new Array();
var imageList = new Array();
var runMouseOvers = true;
var TimerID = null;
var iLimit = 25;
var itmp = 0;

var nbTime = 100;
var nbTimes = 2;
var nbThisLoc = 325;
var aryLayerNames = new Array();
var aryNavBarLayerInfo = new Array();
var aryNavBarLayers = new Array();

var registeredObjects = new Array();
var viz = "hide";

function MOImage() {
	var arg = MOImage.arguments;
	this.ptrImage = BillzNavBarMM_findObj(arg[0]);
	this.imageMO = new Image();
	this.imageMO.src = arg[1];
	this.HTMLname = arg[0];
	this.Moused = false;
	this.OriginalSrc = '';
	return true;
}

function BillzImagePreload() {
	// 0) html image name 1) mo image src 2)image Name for rollover key (rollover may have multiple mos for one html Image) 
	var arg = BillzImagePreload.arguments;
	nbImagePreload(arg[0], arg[1], arg[2]);
}

function nbImagePreload(img_name, mo_img_src, rollover_key_img_name) {
	var imageKey = (rollover_key_img_name.length > 0) ? rollover_key_img_name : img_name;
	imageList[imageList.length] = imageKey;
	if (!(aryMoImages[imageKey])) aryMoImages[imageKey] = new MOImage(img_name, mo_img_src);
}

function BillzMouseover() {
	var arg = null;
	if (runMouseOvers) {		
		arg = BillzMouseover.arguments; //args 0)ImageName 1)OriginalSrc 2)array index (caller imagename)		
		nbMouseover(arg[0], arg[1], arg[2]);
	}
	return true;
}
// args 1) ImageName 2) OriginalSrc 3) array index (caller imagename)
function nbMouseover(img_name, orig_src, img_key) {
	var imageKey = null;
	var o = null;
	if (runMouseOvers) 
	{				
		imageKey = (img_key.length > 0) ? img_key : img_name;
		if (!(aryMoImages[imageKey].ptrImage)) aryMoImages[imageKey].ptrImage = BillzNavBarMM_findObj(img_name);		
		if (aryMoImages[imageKey] && (o = aryMoImages[imageKey].ptrImage)) {
			aryMoImages[imageKey].OriginalSrc = orig_src;
			aryMoImages[imageKey].Moused = true;
			o.src = aryMoImages[imageKey].imageMO.src;
		}
	}
	return true;
}

var NavBarTempOnload = null;
if (window.onload && window.onload != null) NavBarTempOnload = window.onload;

function FullyLoaded() {
	if (NavBarTempOnload != null) NavBarTempOnload();
	runMouseOvers = true;
	return true;
}

function BillzMouseOutTimer() {
	return nbMouseOutTimer();
}

function nbMouseOutTimer() {
	if (TimerID) clearTimeout(TimerID);
	TimerID = setTimeout("nbLayerRestore()",5000);
	return true;
}

function RestoreAll() {
	nbMouseoverRestore();
	nbLayerRestore();
	return true;
}

function BillzMouseoverRestore() {
	return nbMouseoverRestore();
}

function nbMouseoverRestore() {
	var i = 0;
	var o = null;
	if (runMouseOvers) {
		for (i = 0; i < imageList.length; i++) {
			if (aryMoImages[imageList[i]].Moused && (o = aryMoImages[imageList[i]].ptrImage)) {
				o.src = aryMoImages[imageList[i]].OriginalSrc;
				aryMoImages[imageList[i]].Moused = false;
			}
		}
	}
	return true;
}

function BillzLayerRestore() {
	return nbLayerRestore();
}

function nbLayerRestore() {
	var i = 0;
	for (i = 0; i < aryLayerNames.length; i++) {
		if (!aryNavBarLayerInfo[aryLayerNames[i]].isDefault) BillzNavBarRestoreLayers(aryLayerNames[i]);	
	}
	return true;
}

function BillzArrayPushUnique(aryArray, varNewElement) { //only pushes if unique value
	var pushIt = true;
	var i = 0;
	for (i = 0; i < aryArray.length && pushIt; i++) {
		pushIt = (varNewElement != aryArray[i]);
	}
	if (pushIt) BillzArrayPush(aryArray, varNewElement);
	return pushIt;
}

function BillzArrayPush(aryArray, varNewElement) { //Implement Array Push 'cause IE cant handle it
	aryArray[aryArray.length] = varNewElement;
	return true;
}
function BillzArrayPop(aryArray) { //Implement Array Pop 'cause IE cant handle it before 5.5
	var varItemToPop = null;
	if (aryArray[aryArray.length - 1]) {
		varItemToPop = aryArray[aryArray.length - 1];
		aryArray[aryArray.length] = null;
	}
	return varItemToPop;
}

function getDivRef(id) {
	var divref;
	if(ns4) divref = document.layers[id];
	else if(ie4) divref = document.all[id];
	else if(ie5 || ns6) divref = document.getElementById(id);	
	return divref;
}

//v3.0 name changed to avoid clash with possible other JS in content, this function complements of MM Dreamweaver
function NavBarSwapRollover(swapimage,defaultimage,imageID) {
	if(imageID.length > 0 && document.getElementById(imageID))
	{
		if(swapimage.length > 0) 
			document.getElementById(imageID).src = "images/" + swapimage;
		else
			document.getElementById(imageID).src = "images/" + defaultimage;		
	}
}
function BillzNavBarMM_findObj(n, d) {
	var p,i,x;
	if (ns6) x = document.getElementById(n);
	else {		
		if (registeredObjects[n]) return registeredObjects[n];
		if (!(d)) d = document;
		try {
			p = n.indexOf("?");
		}
		catch(e) {
			p = 0;
		}
		if (p > 0 && parent.frames.length) {
			d = parent.frames[n.substring(p+1)].document;
			n = n.substring(0,p);
		}
		if (!(x = d[n]) && d.all) x = d.all[n];	
		for (i = 0; !x && i < d.forms.length; i++) {
			x = d.forms[i][n];
		}
		for (i=0; !x && d.layers && i < d.layers.length; i++) {
			if (d.layers[i].id.indexOf("external_") == -1) x = BillzNavBarMM_findObj(n, d.layers[i].document);	
		}
		registeredObjects[n] = x;
	}				
	return x;
}

function BillzArrayContains() {
	var arg = BillzArrayContains.arguments;
	var foundit = false;
	var i = 0;
	for (i = 0; i < arg[0].length && !foundit; i++) {
		foundit = (arg[1] == arg[0][i]);
	}
	return foundit;
}

function NavBarRegisterLayer() {
	var arg = NavBarRegisterLayer.arguments;
	var n = arg[0];
	var d = arg[1];
	var mo = false;
	var o = null;
	if (arg[2] && arg[2] == 'MOutLayer') mo = true;
	else mo = false;
	
	if (!(BillzArrayContains(aryLayerNames, n))) {
		if (o = BillzNavBarMM_findObj(n)) {
			aryNavBarLayers[n] = o;
			BillzArrayPushUnique(aryLayerNames, n);
			aryNavBarLayerInfo[n] = new NavBarLayer(n, d, mo);
		}
	}
	return true;
}

function BillzNavBarMM_showHideLayers() {
	//v3.0 name changed, this function complements of MM Dreamweaver with customizations by Bill Heller
	var i = 0;
	var x = "";
	var obj = null;
	var v = null;
	var p = null;
	var args = BillzNavBarMM_showHideLayers.arguments;
	
	if (args[args.length - 1] != "menu") nbMouseOutTimer();
	for (i = 0; i < (args.length - 2); i += 3) {
		if (!aryNavBarLayers[args[i]]) {
			x = (args[i + 2] == 'show') ? 'hide' : 'show';
			NavBarRegisterLayer(args[i], x);
		}
		if ((obj = aryNavBarLayers[args[i]]) != null) {
			v = args[i + 2];
			aryNavBarLayerInfo[args[i]].isDefault = false;
			if (args[args.length - 1] == "restore") v = (v == 'show') ? 'hide' : 'show';
			
			if (obj.style) obj.style.visibility = (v == 'show') ? 'visible' : ((v == 'hide') ? 'hidden' : v);
			else obj.visibility = v;
		}
	}
	return true;
}

function BillzNavBarRestoreLayers() {
	var i = 0;
	var x = "";
	var obj = null;
	var v = null;
	var p = null;
	var args = BillzNavBarRestoreLayers.arguments;
	for (i = 0; i < (args.length); i++) {
		if (obj = aryNavBarLayers[args[i]]) {
			v = aryNavBarLayerInfo[args[i]].defaultVisibility;
			if (obj.style) {
				obj = obj.style;
				v = (v == 'show' ) ? 'visible' : ((v == 'hide') ? 'hidden' : v);
			}
			obj.visibility = v;
			if (!aryNavBarLayerInfo[args[i]].MOutLayer) aryNavBarLayerInfo[args[i]].isDefault = true;			
		}
	}
	return true;
}

function NavBarLayer() {
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										  <h1 class="pagetitle" id="pagetitle"><strong>For Patients</strong> / Health Forms</h1>
										
										











	<h2>Forms and Instructions prior to your surgery </h2>
<p>
We want to make sure the day of your surgery goes as smoothly as possible. One way you can help is by coming prepared. Please be sure to follow the instructions given to you by your surgeon. In addition, please review and fill out the attached documents and bring them with you the day of your appointment. Please select the documents below according to the hospital where you are scheduled to have surgery. 
</p>
<h3>For Patients at Ronald Reagan UCLA Medical Center&nbsp;</h3>
<ul>
	<li>Important Information Regarding Your Surgery (<a href="http://www.uclahealth.org/workfiles/documents/healthforms/rr-patient-info-package-2008.pdf" target="_blank" title="Important information regarding your surgery">English</a>&nbsp;or&nbsp;<a href="http://www.uclahealth.org/workfiles/documents/healthforms/rr-patient-info-package-2008-esp.pdf" target="_blank" title="INFORMACI&Oacute;N IMPORTANTE SOBRE SU INTERVENCI&Oacute;N QUIR&Uacute;RGICA">Spanish</a>)<br />
	Please read this carefully and follow the instructions. </li>
	<li>Fill out and bring with you the two attached forms: 
	<ul>
		<li><a href="http://www.uclahealth.org/workfiles/documents/healthforms/admission-medication-history.pdf" target="_blank">Admission Medication History Form</a> </li>
		<li><a href="http://www.uclahealth.org/workfiles/documents/healthforms/medical-history-form.pdf" target="_blank">Health History</a> </li>
	</ul>
	</li>
	<li>Patient Checklist (<a href="http://www.uclahealth.org/workfiles/documents/healthforms/patient-checklist.pdf" target="_blank">English</a>&nbsp;or&nbsp;<a href="http://www.uclahealth.org/workfiles/documents/healthforms/patient-checklist-esp.pdf" target="_blank">Spanish</a>) </li>
</ul>
<p>
Make sure you have completed all the items that pertain to you. 
</p>
<hr />
<h3>For Patients at Santa Monica-UCLA Medical Center and Orthopaedic Hospital </h3>
<ul>
	<li>Important Information Regarding Your Surgery (<a href="http://www.uclahealth.org/workfiles/documents/healthforms/sm-patient-info-package-2007.pdf" target="_blank">English</a>&nbsp;or&nbsp;<a href="http://www.uclahealth.org/workfiles/documents/healthforms/sm-patient-info-package-2007-esp.pdf" target="_blank">Spanish</a>)<br />
	Please read this carefully and follow the instructions. </li>
	<li>Fill out and bring with you the attached form: 
	<ul>
		<li><a href="http://www.uclahealth.org/workfiles/documents/healthforms/sm-admission-medication-history.pdf" target="_blank">Admission Medication History Form</a><a href="http://www2.healthcare.ucla.edu/healthforms/medical-history-form.pdf" target="_blank"></a> </li>
	</ul>
	</li>
	<li>Patient Checklist (<a href="http://www.uclahealth.org/workfiles/documents/healthforms/sm-patient-checklist.pdf" target="_blank">English</a>&nbsp;or&nbsp;<a href="http://www.uclahealth.org/workfiles/documents/healthforms/sm-patient-checklist-esp.pdf" target="_blank">Spanish</a>)</li>
</ul>
<p>
Make sure you have completed all the items that pertains to you. 
</p>
<p>
To view these forms, Adobe Acrobat Reader is required. 
</p>
<p>
<a href="http://www.adobe.com/products/acrobat/readstep2.html" target="_blank"><img class="sm6generalwizard" src="http://www.uclahealth.org/images/get_adobe_reader.gif" border="0" width="88" height="31" style="font-size: 11px" /></a> 
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