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Healthcare for the community by people who care

Patient Forms

Welcome to Carter Medical Clinic in Altus, OK. For the convenience of our existing and future patients we have downloadable forms for new patients and to update current paperwork, which we like to do annually.

To apply to become a new patient with the clinic please complete the following form and return to the office either by fax, mail, or in person. We would like to make you aware that at this time our Medicare, Medicaid, and Tricare panels are at capacity, and we will not be accepting any new patients at this time, however; we will keep your new patient application on file for when space becomes available.

New Patient Application

For all of the newly accepted patients, the following forms are required to be completed at your initial visit in our office. Please have them complete to expediate your check-in process on the day of your New Patient Visit.

The completed New Patient Application can also be emailed to: ruthjones@carterclinicok.com

Demographics Information Form This may also be completed by patient’s that need to update phone numbers, addresses, etc.

HIPPA Consent Form

History and Physical Form

Please read the following policies and procedures for Carter Medical Clinic, as well as our HIPPA Notice Disclosure by downloading our patient pamphlet. Pamphlet

Please download and read the Notice of Privacy Practices, which describes how medical information about you may be used and disclosed and how you can get access to this information. Notice of Privacy Practices

If you would like any person(s) to have access to your information including billing information with Carter Medical Clinic, the following form must be completed. Authorization to Disclose Protected Health Information

If you would like to request for any records from this office (at a charge) or for us to receive records from an outside entity (free service), the following form must be completed by the patient. Medical Records Request Form

Dr. Charles C. Carter is offering a secure, HIPPA compliant communication tool, known as the patient portal, as a courtesy to our patients. Please download this form and bring it to your next visit to allow us to enroll you.

Patient portal form – consent form to use our online patient portal to access your medical information.

Carter Medical Clinic also participates in electronic prescriptions and the e-Prescribing Consent Form Must be signed for all patient’s to receive their prescriptions from this office. e-Prescribing Consent Form

Please feel free to leave us feedback on your service with us with our Patient Survey.

CLINIC evaluation form

If you are interested in employment opportunities you may fill out the following application and return it to the office manager, Anna Miranda. We are currently not hiring any positions, however; applications will be kept on file for future opportunities.

Carter Medical Clinic Employment Application

Dr. Carter’s office is a participant in MyHealth and you are included in the network.  You may opt out or revoke your opt-out decision if you wish. See what that means and how to do it using the forms below.  You may mail the forms in directly after a notary verifies, your identity, or simply deliver the form back to Dr. Carter’s office.

MyHealth Opt-Out Form

Return to MyHealth Form