The following forms and documentation have been provided to help our occupational health clients and their employees have a more streamlined St. John experience.
COMPANY PROFILE
St John Urgent Care looks forward to working with you to meet all your occupational health needs. The information we obtain from the company profile is put into our system to make each visit hassle-free. This will lessen the phone calls to your company or contact person. All of our locations are connected by one computer system, so regardless of the St. John Urgent Care location you visit, our staff will have access to the information you have shared with us on your profile.
AUTHORIZATIONS TO TREAT
Employer Authorization to Treat Form
Human resource department or applicable company contacts: Please complete and sign employer authorization to treat form for any patient coming to one of our four convenient locations. This form will be for all first reports of injury or for pre-placement physicals, DOTs, drug screens or testing. The patient may present this form to the receptionist upon check in, or the supervisor/company contact may fax a completed and signed form to the location where the employee will be sent for treatment.
Patient Information Authorization Form
Every patient must complete and sign a patient information authorization form before their visit. For your convenience, the patient may complete this form in advance and present it to the treating facility upon arrival.
Pre-Placement or Return to Duty Physical
If your employees are coming in to one of our locations for a pre-placement physical or a return to duty physical, please request they complete this medical history form and present it to the treating facility upon arrival.
TESTING QUESTIONNAIRES AND FORMS
St. John Occupational Health Care offers audio, pulmonary function and vision testing, as well as respiratory medical evaluations.
