\

New Patient Instructions Prior to Initial Visit

Health History Time Line:

Please create a timeline of your health history starting from the time of conception (mother’s womb) to now. Put a long horizontal line on a piece of paper and plot below the line health moments in your life. Above the line, please note environmental exposures not limited to the following: amalgam placement/replacement, root canals, water damage in the home/leaks, moving to a new home with damp basement, work place, living near farms with pesticides, cell phone tower near home, high voltage power lines near home, vaccination, traveling history with infections/gut infections, etc.

The first 30 minutes of the first visit we will do a timeline, investigating your environmental exposures. If you start this process on your own, this will save a lot of time. Also, it will help you think through your history before the appointment.

Past Laboratories, Imaging results, Functional Medicine Consultations, etc. :

Please send all your prior lab work, test results and Previous Medical History if you have them. You can have this information sent to me via e-mail . This is not HIPPA secure. Currently, I am setting up a secure service with a vendor. So you might want to consider waiting before sending me any documents, you do not want in unsecured e-mails. I do delete the files right away after downloading. But again, these are not HIPPA secured yet. In two weeks, it will be.

New Laboratories to be performed prior to Initial Appointment:

Dr. Dan would like particular laboratories done prior to your first Initial visit with him. It includes lab work that needs to be done at both Quest and Labcorp laboratories. Groton Wellness staffing will send you both laboratory requisitions to you upon booking your Initial appointment.

Please go toLabcorpandQuest to get both the blood work done 2-3 weeks prior to the first visit. You may google Labcorp patient service center and Quest patient service center to find the nearest lab. Please pint the full requisition form and fill in your name and DOB before going to either lab. You can fax the lab requisition forms to each laboratory the day before or drop it off physically—it takes a longer time for the phlebotomist to input the various labs into their system. The phlebotomist may also have questions about the laboratories, so please make sure the phlebotomist calls Dr. Dan if they have any questions. Also, laboratories are not allowed to tell you if your insurance covers the labs—although they do have a system to check. You will need to call your insurance company to ensure the laboratories will be covered. Some of the labs take 2-3 weeks to come back, so the earlier you go toQuestandLabcorp, the quicker we can get started.

If your insurance does not pay for one of the laboratories, you may e-mail me at . We can figure out which ones we can eliminate so it reduces your overall costs. Call me at 617-596-1092 or 603-291-0783

The Quest labs that will be run will require fasting overnight. So it means when you wake up on the day of the blood draw, you cannot eat breakfast (water is o.k., but no other beverages) before going to the laboratory. Labcorp, does not require any fasting.

Dr. Daniel Cagua-Koo, MD MPH

, www.riveroflifemedical.org

603-291-0783