Patient Forms

Meet Dr. Syed Alam, MD, FACR

Double Board-Certified, Fellowship-Trained Rheumatologist · Musculoskeletal Ultrasound Trained · 10+ Years of Experience

Dr. Alam completed his rheumatology fellowship at Temple University Hospital after an internal medicine residency at John H. Stroger, Jr. Hospital. His clinical interests include rheumatoid arthritis, lupus, psoriatic arthritis, gout, Sjögren’s disease, osteoporosis and other rheumatic conditions.

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Downloading the forms

PLACEHOLDER: the practice packet has not yet been finalised, so no forms are available to download from this page. Once the documents exist they should be uploaded as tagged, accessible PDFs and linked here individually with their file size, so that patients on a phone know what they are opening.

PLACEHOLDER: state whether a patient portal will be used, and if so, whether forms are completed within the portal instead of on paper.

In the meantime, our office can send the paperwork to you before your appointment. Ask when you book.

What the packet contains

Most rheumatology new-patient packets contain the same six components, and each exists for a reason worth knowing.

Registration and demographics

Name, date of birth, address, contact details, emergency contact, employer and insurance information. This is the part that goes to billing, and errors here are the most common cause of a rejected claim months later.

Medical history

The longest section, and the one that does the most work. It asks about current and past illnesses, surgery, hospital admissions, allergies and family history. In rheumatology the family history questions matter more than people assume, because psoriasis, inflammatory bowel disease, thyroid disease and inflammatory arthritis cluster in families.

Medication list

Every prescription with its dose, plus everything taken without one. Supplements belong here too.

Symptom review

A checklist covering the whole body rather than only the joints, because rheumatic diseases affect skin, eyes, bowel, lungs and blood vessels. Ticking a box about dry eyes or a rash frequently changes the direction of a first appointment.

Consent and privacy

Consent to treatment, acknowledgement of privacy practices under federal law, and financial responsibility. Read these rather than signing blind; they set out what happens to your information and who is responsible for the bill.

Records release

The authorisation that lets us request your notes and results from other practices. Completing this early is what makes prior records arrive before your appointment rather than after it.

Photograph for illustration only. No patient of this practice appears in it.

Completing the forms well

The difference between a form filled in properly and one filled in hurriedly is measured in appointment minutes, and those minutes come out of the time available to examine you and explain what is happening.

• Fill them in at home, where your medication boxes and old letters are to hand
• Give doses as well as drug names, since the dose often matters more
• Include medicines you stopped, and say why you stopped them
• Give approximate dates rather than leaving a date blank; a rough year beats nothing
• Answer the symptom checklist honestly even where an item seems unrelated to your joints
• Leave anything you genuinely do not know blank rather than guessing

That last point matters. A guessed date or a half-remembered drug name is worse than an empty box, because it gets recorded as fact and can quietly misdirect the assessment for years.

Privacy and your records

Everything on these forms is protected health information under the federal Health Insurance Portability and Accountability Act. In practice that means it can be used to provide your care, to bill for it and to run the practice, and beyond that it is not disclosed without your authorisation, apart from a narrow set of legally required exceptions.

You have rights over this information that are worth knowing: to see and obtain a copy of your record, to ask for corrections, to be told who your information has been disclosed to, and to request that we communicate with you in a particular way, such as only by mobile phone.

The records release form works in the other direction, authorising us to request information from practices that have treated you. It is specific rather than open-ended, and you can limit what it covers.

PLACEHOLDER: link the practice notice of privacy practices once written, and name the privacy officer and their contact details.

Requesting a copy of your own records

You have a legal right to a copy of your medical record, and in rheumatology there are several good reasons to exercise it: moving away, seeking a second opinion, applying for insurance or disability, or simply wanting the results in your own hands before the next appointment.

The request has to be in writing, and it helps to be specific about what you want. Asking for everything produces a large file in which the useful parts are hard to find. Asking for laboratory reports from a stated period, imaging reports and clinic letters usually produces what is actually needed.

What to expect

• A written authorisation, signed and dated, naming what is to be released and to whom
• A response within the period federal law allows, usually thirty days
• A reasonable, cost-based fee for copying, which cannot be a charge for retrieving or searching
• Electronic delivery where the record is held electronically and you ask for it that way

If you are moving your care elsewhere, having your own copy in addition to the transfer is worth the small effort. Practices close, systems change, and the copy in your possession is the one that does not depend on anyone else's filing.

PLACEHOLDER: confirm the records request process, the fee, the turnaround time and whether records can be released electronically or through a patient portal.

Forms you may be asked to complete later

The new-patient packet is not the only paperwork in rheumatology. Several documents appear later in the course of treatment, and knowing they exist prevents them arriving as a surprise.

• Disease activity questionnaires, short scored forms completed at intervals to track whether treatment is working
• Function and quality-of-life questionnaires, which measure what you can actually do rather than how you feel
• Treatment consent forms for specific medicines, particularly biologics and immunosuppressants
• Prior authorization documentation, most of which our office completes rather than you
• Disability, insurance or employer forms, which usually require a fee and a lead time

The disease activity questionnaires deserve a word. They look like bureaucracy but they are how treatment decisions get made objectively rather than impressionistically. A score that has not improved after three months is what justifies changing a medicine, and increasingly it is what an insurer requires before approving the next one.

PLACEHOLDER: confirm the fee and turnaround time for completing disability, employer or insurance paperwork.

PLACEHOLDER: this page describes the forms in general terms because the practice has not yet finalised its packet. Before launch, upload the actual forms as accessible PDFs, link them here, and replace every description below with the real document. Confirm how patients return completed forms and whether a patient portal will be used.