Inland Orthopaedic Surgery & Sports Medicine Clinic

Rehabilitation Protocols	Insurance Contract Information	Patient Forms
Moon ACL Guidelines
ACL Insufficiency		Forms for Edwin M. Tingstad, M.D. Please complete each of these forms and bring to your appointment: - Patient Information Sheet - Authorization to Disclose Medical Info - Patient Signature for non contracted insurances - Medicare Beneficiary Signature Page - Notice of Privacy Practices Acknowledgement - Medical History Form - Knee Form - Shoulder Form Forms for Steven E. Pennington, M.D. Please complete each of these forms and bring to your appointment: - Patient Information Sheet - Authorization to Disclose Medical Info - Patient Signature for non contracted insurances - Medicare Beneficiary Signature Page - Notice of Privacy Practices Acknowledgement - Medical History Form Forms for Charles A. Jacobson, M.D. Please complete each of these forms and bring to your appointment: - Patient Information Sheet - Authorization to Disclose Medical Info - Patient Signature for non contracted insurances - Medicare Beneficiary Signature Page - Notice of Privacy Practices Acknowledgement - Medical History Form
Arthroscopic Acromioplasty
Shoulder Impingement
Meniscal Repair
Patellafemoral Pain
Posterior Shoulder Stabilization
Postop Elbow
Rotator Cuff Repair
Shoulder Anterior Instability
SLAP Repair
Total Knee Replacement
Meniscus Transplant
Ulnar Collateral Ligament
Part 1
Part 2
Hop Test
Shoulder Arthroplasty
Achilles Tendon Repair		Notice of Privacy Practices Financial Billing Policies
Oats Protocol