Aucnylakesuccess.com

Our Practice – Lake Success Urology

Prostate cancer screening and early detection with a full range of individually tailored treatment options including active survelience, radiation therapy, … See more

Actived: 9 days ago

URL: https://www.aucnylakesuccess.com/about-us-php/our-practice/

Lake Success Urology – Centers of new york

WEB2001 Marcus Avenue - Suite N 214 Lake Success, New York 11042. 516-437-4228. 516-355-0637. Call today for urgent appointments

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Jason T. Rothwax, M.D. – Lake Success Urology

WEB2001 Marcus Avenue - Suite N 214 Lake Success, New York 11042. 516-437-4228. 516-355-0637. Call today for urgent appointments

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Physicians – Lake Success Urology

WEB2001 Marcus Avenue - Suite N 214 Lake Success, New York 11042. 516-437-4228. 516-355-0637. Call today for urgent appointments

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Appt Date Patient Registration Date of Birth

WEBPatient Name Date of Birth Primary Insurance Information Medicare Medicaid Health Insurance Self Pay Worker’s Comp No Fault

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Michael A. Levine, M.D., F.A.C.S. – Lake Success Urology

WEB2001 Marcus Avenue - Suite N 214 Lake Success, New York 11042. 516-437-4228. 516-355-0637. Call today for urgent appointments

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Medical Records Online Request – Lake Success Urology

WEB2001 Marcus Avenue - Suite N 214 Lake Success, New York 11042. 516-437-4228. 516-355-0637. Call today for urgent appointments

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Insurance – Lake Success Urology

WEB2001 Marcus Avenue - Suite N 214 Lake Success, New York 11042. 516-437-4228. 516-355-0637. Call today for urgent appointments

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Vasectomy – Lake Success Urology

WEB2001 Marcus Avenue - Suite N 214 Lake Success, New York 11042. 516-437-4228. 516-355-0637. Call today for urgent appointments

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Your Billing Rights – Lake Success Urology

WEB2001 Marcus Avenue - Suite N 214 Lake Success, New York 11042. 516-437-4228. 516-355-0637. Call today for urgent appointments

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Enlarged Prostate – Lake Success Urology

WEB2001 Marcus Avenue - Suite N 214 Lake Success, New York 11042. 516-437-4228. 516-355-0637. Call today for urgent appointments

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Our Staff – Lake Success Urology

WEB2001 Marcus Avenue - Suite N 214 Lake Success, New York 11042. 516-437-4228. 516-355-0637. Call today for urgent appointments

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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION …

WEB2 Uses and Disclosures of Protected Health Information Based upon Your Written Authorization Other uses and disclosures of your protected health information will be …

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Prostate Biopsy Consent Form

WEBTelephone: 516-437-4228 Facsimile: 516-355-0637 www.AUCNYLakeSuccess.com 2001 Marcus Avenue Suite #N214 Lake Success, NY 11042 Lake Success Division Mitchell I

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Male Patient History Form May2013

WEBName:_____ Date of Birth:_____ International Prostate Symptoms Score (IPSS) Questions half the Not at all

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Female Patient History Form may2013

WEBName:_____ Date of Birth:_____ Social History: Do you currently smoke? !Yes !No If yes, how much?_____

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Authorization to Disclose Protected Health Information The …

WEBAuthorization to Disclose Protected Health Information The undersigned authorizes . Integrated Medical Professionals . 1 Hollow Ln. #206Lake Success, NY 11042

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Acknowledgement of Receipt of Privacy Practices

WEByes no Answering Machine yes no Work # _____ yes no Voice Mail # yes no Cell # Acknowledgement of Receipt of Privacy Practices Patient Name Date of Birth I have

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