PATIENT FORMS

DOWNLOAD PATIENT FORMS

Thank you for choosing Dr. Douglas Brown and his staff at the Orthopaedic Center of Monroe. Below are the new patient forms you need for a first-time visit to our office. Arrive early so that you can present these completed forms to the receptionist. Please remember to bring photo identification and your insurance card for your initial visit.

If you have not yet made an appointment, please call (318) 323-6603.

PATIENT REGISTRATION FORM

PRESCRIPTION REFILL POLICY

PRIVACY PRACTICES FORM

AUTHORIZATION TO RELEASE RECORDS

RECEIPT OF PRIVACY PRACTICE

Health Services Information

PRESCRIPTION REFILL
INSURANCE INFORMATION
I'M SCHEDULED FOR SURGERY
DISABILITY CLAIMS, WORKER'S COMP, LIABILITIES
PRESCRIPTION REFILL

PRESCRIPTION REFILL

 

When a patient is seen in the office and requires a prescription, the treatment regime will cover the prescriptive needs until the next appointment. Refills on medication will only be authorized after the patient is seen in the office. No refills will be given after you leave the office that day or the next 3 days. We cannot refill prescriptions over the phone or online. If an appointment is missed, no refills will be authorized without a return appointment. We do not take prescription refill requests after 12:30 on Fridays, after hours, or on weekends.

 

If you are changing pharmacies, you can usually have your new pharmacy request that your prescriptions be transferred from your old pharmacy.

INSURANCE INFORMATION

Insurance Information

 

The Orthopaedic Clinic of Monroe accepts most insurance plans. If you do not see your insurance company on the list below, call our office for additional information on plans not listed.

 

• Blue Cross/Blue Shield

• United Heathcare

• Signa

• Vantage

• Humana

• Meritain

• Benefit Managers

• Champva

• Medicare with supplement

• Others

 

I'M SCHEDULED FOR SURGERY

I’m Scheduled for Surgery

 

We understand surgery can be intimidating. Dr. Brown and his staff are highly experienced in surgeries and understand your concerns.

 

Prior to your surgery, make sure you review and update your medications. Present these to the staff when you arrive. Also bring your insurance card, photo id, and any X-rays and MRIs you have relating to your injury.

 

Review the information your nurse gave you at your last appointment. Follow all directions on the pre-op forms and remember to get a good night’s sleep - you are in the hands of Dr. Brown and his staff!

DISABILITY CLAIMS, WORKER'S COMP, LIABILITIES

Disability Claims,  Worker’s Compensation,  Liabilities

 

If you have a disability claim, suffer from a work place injury, or have a liability injury, our office has skilled employees who are trained to handle paperwork in each area.  We work with risk managers, human resource professionals, lawyers and insurance companies that monitor each case. We will help you handle all your paperwork and filings.

 

For information on you or your client’s case, please call our office at (318) 323-6603 and ask to speak with one of the following:

Disability Specialist

Worker’s Compensation Specialist

Liability Technician

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LOCATION

312 Grammont St. Suite 302
Monroe, Louisiana

CONTACT INFO

Phone: (318) 323-6603
Fax: (318) 387-3601
info@douglascbrownmd.com