Heart Patient Forms

Below are some of our most used documents and forms. Please take a moment to print and complete the appropriate forms as needed.

  • Notice of Privacy Practices - This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
  • Patient Authorization Record - Form Authorizes Cardiology to release patients records to a facility or doctor. This form must be completed in its entirety before any information will be released.
  • FMLA - Disability Forms - Cardiology will complete forms for FMLA or disability only if the leave is a result of the patient’s cardiac condition.The patient must answer all of the following questions, sign a release and pay $25 when leaving the required paperwork at Cardiology.
  • New Patient History Form - Please speed up your initial appointment time in the office by completing and printing the New Patient Forms.
  • Provider to Provider Letter - Sometimes we will need medical information from other doctors or facilities who have treated you. This form is used to request medical information.

Contact Us

Cardiology - 270-417-7500 or 800-304-0808

Cardiothoracic Surgery - 270-417-7510

24-Hour Health Information Line - 855-417-8555

Owensboro Health Main Line - 270-417-2000

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Owensboro Health Regional Hospital

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