Surgicenter CareFlow Demo

Welcome to the WiCis Health - Surgicenter CareFlow System

Your surgical procedure is fast approaching and we need some information to better serve you! 

Approximate time you will need to fill out this information is 10-30 minutes depending on the complexity of your medical history...

(c) WiCis Inc. 2018

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Current Medications has no list assigned

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Other Medications

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Past Surgical History

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Anesthesia Complications

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Other Medical History

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Cardiac History has no list assigned
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Bone / Joint Disease has no list assigned
Nervous System Disease has no list assigned
Bleeding Problems has no list assigned
Thyroid / Liver Diseases / Kidney Diseases has no list assigned
Dental / Vision / Hearing has no list assigned
Other Diseases or Issues has no list assigned
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Recreational Drug Substances has no list assigned
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Personal Health Information - E-Mail Communication Preferences

In order to best serve our patients and communicate regarding their services and financial obligations we will use all methods of communication provided to expedite those needs. By providing the information above I agree that our Surgery Center or one of its legal agents may use the telephone numbers provided to send me a text notification, call using a pre-recorded/artificial voice message through the use of an automated dialing service or leave a voice message on an answering device.

If an email address has been provided, this Surgery Center or one of it's legal agents may contact me with an email notification regarding my care, our services, or my financial obligation.

I recognize that text messaging is not a completely secure means of communication because these messages can be accessed while in storage or intercepted during transmission. The text messages you recieve may contain your personal information. If you would like us to contact you by text message please sign this consent below. If you consent to receiving text messages you also agree to promptly update this Surgery Center when your mobile phone number changes. You are not required to authorize the use of text messaging and a decision not to sign this portion of the authorization will not affect your health care in any way.

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I acknowledge that I have been given the opportunity to request restrictions on use and/or disclosure of my protected health information.

I acknowledge that I have been given the opportunity to request alternative means of communication of my protected health information.

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