When you come for your first visit with us, please BRING YOUR COMPLETED history and registration forms. Give the completed forms to our receptionist. She will ask you for your insurance cards and make a copy for your chart.

You will need to bring the following items with you to the office

• All of your current medication bottles.
• Past medical records, including any cardiac or vascular testing.
• The name, address and Telephone number of any out-of-town physicians.
• Any forms you have been asked to bring.
• Insurance cards.
• Wear or bring comfortable, loose-fitting clothing and walking shoes with rubber soles.

Preparation for Stress Test

• Nothing to eat or drink for 3-4 hours prior to taking the test (other than medication).
• Wear comfortable loose fitting clothes and walking shoes with rubber soles.

Preparation for Nuclear Studies

• Nothing to eat or drink for 6 hours before the test (other than medication) if the test is combined with a stress test. This may not be necessary if the test is being done in a resting state.
• Do not have any caffeinated substances such as coffee, tea or chocolate 24 hours prior to the test.
• Some medications also contain caffeine and should NOT be taken 24 hours prior to the test. Check with the office.
• Smoking raises the heart rate and blood pressure, tobacco in any form should be avoided four (4) hours prior to testing.
• Wear comfortable loose fitting clothes and walking shoes with rubber soles.
• If you are pregnant (or suspect that you might be pregnant), let your doctor or nurse know. Such tests should not generally be done on pregnant patients.

Preparation for TEE

• Do Not eat or drink for 4 hours prior to your procedure.
• You must be accompanied by someone who is able to drive you home due to the sedation utilized for the test.
• Please remember to get your lab work done at least 48 hours prior to the procedure. Women do not wear finger nail polish on the day of the test.

Patients should bring their “prescription bottles” with them to their office visits.  This will assist the physician and nursing staff with making sure that we have a complete and accurate record of all medications you are taking.  Additionally, make sure you tell us of all “over-the-counter” and “herbal” medications that you may be taking as these may interact with prescription medications that may be prescribed to you.

It is the policy of the Mid-Ohio Heart Clinic to only renew prescriptions that have been written by our physicians.

When you come for any office visit, we will renew all prescriptions for the following 12 months.  Please make sure this is completed before you leave the Clinic. 

If you require a prescription renewal by phone, you are to call our office at 419-524-8151 and follow the instructions to be transferred to the “prescription refill” option.  Any patient seen in the office after January 1, 2008 who calls for a prescription refill, will be required to pay a fee of $5.00 per prescription before the refill will be completed. 

When leaving the information on the “prescription refill line”, please provide the following information:

• Patient Name

• Patient Date of Birth

• Patient Address

• Phone number at which the patient can be reached

• Pharmacy name, location and phone number

• Prescription with dosage that requires refilling

The patient can pick up their prescription refill forms at the office between 8:00 AM and 5:00 PM Monday thru Friday after prescription fee is paid.  This fee is waived for patients who have problems with the medication prescribed and either the dosage or prescription itself must be altered.

Those patient’s who require that the refill be called in, must be connected with the “front desk” staff so that credit card information is obtained for payment of the prescription refill fee.

Please allow a minimum of 24 hours for prescriptions renewals so that your medical record can be pulled and information verified/reviewed by the nurse and physician.

Dowload any of the following patient forms:

Patient Registration

Patient Medical History

Privacy Policy

Patient Instructions

Tilt Table Test Instructions

Stress EchoCardiogram Instructions

Cardiac Stress Test

Nuclear Cardiac Stress Test

Notice of Privacy Practices

Family Medical Leave Act (FMLA) Forms are completed as a courtesy to patients and/or immediate family members who have employers that require these documents.  Please bring in or drop off the forms along with a pre-addressed and postage pre-paid envelope.  Forms may take up to 7 days to complete.

Personal Disability Forms for personal disability insurance policies, credit cards, mortgage payments, car payments, etc. may be dropped off at the front desk of the Mid-Ohio Heart Clinic.  There is a $10.00 fee for the completion of EACH FORM.  Payment must be made in advance for the processing of these forms. Please allow 7 business days for the completion of these forms.

Disability Assessment Forms are forms that are separate and distinct.  The physician must examine the patient in most cases to assure the accuracy of the information provided.  Most health insurance companies do not provide coverage for these services.  As such, our normal office visit or consultation fee may be the responsibility of the patient if these services are not covered by your health insurance company.