Ethical Health Partnerships

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Handouts & Forms for Patients & Medical Offices

Permission to Duplicate :
You are welcome to duplicate any materials that you download for your office or patients hosted on our site. We ask only that you keep our identifying information (just name and website) on all materials that you use. If you have feedback or concerns about anything we have included, please contact us. We want to continue revising the materials to best meet your needs.

Patient Safety Medication Safety Download (PDF)
For patients -- ways to increase safety, questions to ask physician, information to give physician, etc. Section at end to put your office name and contact information for patient.
  Medication List for Patients (PDF)
List for patients to keep track of medications and provide info to family and physicians.


Take Action to Prevent Medicare Reimbursement Cuts
Flyer you can duplicate in your office. Outlines points for letters to Congress & contact information for Florida Senators and Central Florida Representatives. (We hope to have a generic version to customize for your area. If you would like one, let us know and we will get it to you faster if we know there is interest.
(You can duplicate the forms listed. Permissions and restrictions are indicated on the host site.)
Practice Management Improving Claims Processing and Payment: A Self-Assessment Tool for Providers
Created by the American College of Obstetricians and Gynecologists. Site also has downloadable Claims Correction Form and Coordination of Benefits to help reducing delays.

As always, I welcome your constructive comments and suggestions about the material on this website and how we can all be most effective in co-creating the kind of healthcare system we all want.
E-mail me at
© Dawn Lipthrott, Ethical Health Partnerships, 2004

(May be copied and distributed as long as this identifying information is retained on copies.)

About Us | Site Map | Privacy Policy | Contact Us | ©2005 Ethical Health Partnerships, Dawn J. Lipthrott, LCSW