F. Hammond Cole, Jr. MD, FACS
Jonathan J. Ellichman, MD
O. Brewster Harrington, MD, FACS
A. Alim Khandekar, MD, FACS
G. Phillip Schoettle, Jr., MD, FACS
John Wise, PA-S
Memphis Medical Center 1325 Eastmoreland Ave., Suite 220
Memphis, TN 38104
901-725-9450
Fax: 901-274-0741
Toll Free: 1-800-489-9450
Click here for a map
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Adult Thoracic and Cardiovascular Surgery
UT Medical Group, Inc.'s trained Surgeons utilize state-of-the-art technology and minimally invasive approaches for the surgical treatment of Thoracic and Cardiovascular Surgery.
We work closely with other specialists including gastroenterologists, medical & radiation oncologists, gynecologists, and urologists for care of patients with complex disorders.
The UTMG Department of Surgery physicians maintain privileges at the major hospital systems in Memphis, including The Regional Medical Center (The Med), Baptist Memorial Hospital, Methodist University Hospitals of Memphis, and the Memphis Veterans Administration Medical Center (VAMC).
UTMG Forms for New Surgery Patients:
We look forward to your visit to our office! We require that you complete the following forms to assure that:
- you are familiar with our privacy practices
- we maintain an accurate medical history
- we have information on your other health providers who might need access to records from your visit
- we have accurate insurance information
Please see the table below containing the links and instructions for the forms:
|
Form
Click on the form name to download it. |
Instructions |
Required
for new
Patients |
| HIPAA Notice of Privacy Practices (2006) |
Print and retain for your records |
Yes |
| HIPAA Summary of Notice of Privacy Practices |
Print, sign, and bring to the office |
Yes |
| Authorization to Obtain, Use, and/or Disclose Health Information |
Print, complete, sign, and bring to the office |
Yes |
| Surgery Patient Information Form |
Print, complete*, sign, and bring to the office |
Yes |
* You may type onto the starred UTMG Surgery forms on a computer and print them out with the information you added. However, these forms cannot be saved on the computer with your data on them.
Links:
| Information and links found on the UT Medical Group, Inc. web site are neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition. If you think you may have a medical emergency call your healthcare provider immediately. |
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