FMO General Internal Medicine

Quick Links

Clinical Desktop

Clinic Notes

• Adult Past Medical Family Social ROS Form:  English  |  Spanish 
• Adult Past Medical Family Social ROS with CAGE Questions:  English  |  Spanish 
• FMO Resident Progress Note 
• FMO New Patient History & Physical

Referrals

Order Forms

• Electromyography Lab
• GI Clinic H Pylori Breath Test
• LLUHC Ear Lavage Form
• Pulmonary Function Testing
• Sleep Study

Consent / Authorization Forms

• Consent for Treatment
• Electronic Prescription History Authorization
• HIV Testing Consent Form

Patient Health Maintence Records

• FMO Blood Glucose Records
• FMO Blood Pressure Records

Patient Handouts

• LLUMC Upper Endoscopy Prep Instructions

Calculators (Internet Links)

Immunization

• CDC Website
• Adult Immunization Schedule
• Adult Checklist - Do I need vaccinations today?

DMV Forms (Internet Links)

• Website
• Disabled Placard Application (Reg 195)
• Driver medical Evaluation (DS 326)
• Medical Examination Report (DL 51)