Occupational Medicine & Wellness - Wheaton Franciscan Healthcare

Prior to sending a patient to Occupational Medicine and Wellness, you may print the following Authorization Form. This form is not required but can be beneficial to both our staff as well as your employee. In addition to providing our staff with the pertinant information needed when treating your employee, it provides the patient with a map and contact information should they need to schedule or change an appointment.

docs/Occ Med pre auth form Map 1-20-09.pdf

The Wheaton Franciscan System is committed to protecting the privacy and confidentiality of patients’ protected health information and has had practices in place for many years to respect patients’ right to privacy. In response to the Health Insurance Portability and AccountabilityAct of 1996 (HIPAA), we are pleased to provide our patients with a Notice of Privacy Practices as they enter our facilities for health care services.

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