for Multicare Associated Clinics
Multicare Associates offers the following forms and instructions.
Records Release Form
There comes a time when nearly every patient needs a copy of their medical records or needs documentation of specific health information contained in their record. Because patient information is private and confidential, a valid authorization must be obtained. Multicare has a team of individuals solely focused on maintaining, storing and releasing patient information.
Fridley Medical Center - Fax: (763) 785-3329
Blaine Medical Center - Fax: (763) 785-8424
Roseville Medical Center - Fax: (763) 785-7716
More Information and Instructions | Records Release Form
Authorization to Discuss Protected Health Information
You may use this form to allow your healthcare providers to disclose, access, and use your health information from services provided.
Authorization to Discuss Protected Health Information Form
Download the Employer Authorization for Care form
Patient Portal Registration form
Tips for Any Appointment - This paper provides you with a check list of information that you may want to discuss with your Health Care Provider. Print Communicate with Your Health Care Provider, write reminders on it, and bring it with you to your appointment.
Communicate with your Provider
Charges and How They Relate to Preventive and Problem-Oriented Visits - This paper discusses insurance coverage and how portions of an office visit can be interpreted differently for reimbursement purposes.
Important Facts for our Patients Regarding Preventive and Problem-Oriented Services Given In the Same Visit
Tests and Examinations - is a chart that shows what you might expect when you see your health care provider.
Test and Examination Expectations
Female Exam Form - Download Female Preventative Physical Exam Form
Appointment Prep Instructions
Adult Physical Exam - For information regarding your adult physical exam and preparations for the visit, read and/or print Adult Physical Exam Instructions. If you have scheduled a blood draw for cholesterol or diabetes - prepare by following the instructions in Patient Preparatory Instructions Fasting Blood Work.
Adult Physical Exam Instructions | Patient Preparatory Instructions Fasting Blood Work
*Assessments / Questionnaires will not be evaluated without an appointment
ADHD / ADD Assessment - If the doctor is assessing the patient for ADHD or ADD and you are the parent, please print and complete the History form for ADHD Assessment. This form needs to be filled out before arriving at the clinic for the appointment.
History form for ADHD Assessment
ADHD / ADD Assessment - If the doctor is assessing the patient for ADHD or ADD and you are the parent, please print and complete the NICHQ Vanderbilt Assessment Scale (Parent). This form needs to be filled out before arriving at the clinic for the appointment.
NICHQ Vanderbilt Assessment Scale (Parent)
ADHD / ADD Assessment - If the doctor is assessing the patient for ADHD or ADD and you are the patient's teacher, please print and complete the NICHQ Vanderbilt Assessment Scale (Teacher). This form needs to be filled and mailed to the clinic as quickly as possible.
NICHQ Vanderbilt Assessment Scale (Teacher)
Kindergarten/Pre-school medical examination form is for children ages four and older when they are entering the school system. Please print the Kindergarten Physical Questionnaire, complete it, and bring it with you to the appointment.
Kindergarten Physical Questionnaire
3-hour Glucose Tolerance Test - follow these instructions if you are having this lab test.
3-hour Glucose Tolerance Test Instructions
Glucose Testing - for the types of regular glucose testing: standard, two-hour post prandial, glucose tolerance test, one-hour glucose test for OB patients, two-, three-, and five-hour glucose test (for all patients); please follow the instructions in Glucose Testing.
Glucose Testing Instructions
New Patients With Our Dietician - when an appointment for a new consult is scheduled with our dietician. Print the form now, complete it, and bring it with you to the appointment.
New Dietician Patient Food Diary