Forms

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" bgproperties="fixed" background="06b285a1erlcgo.png"> <div> <FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>DR. DIANE L.OZOG & ASSOCIATES    </B></FONT><B>    </B><B> |     </B><A HREF="index.htm" TARGET="_top" TITLE="DR. DIANE L.OZOG ASSOCIATES "><U><B>home</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="About Us"><U>About Us</U></A>   |   <A HREF="id40.htm" TARGET="_top" TITLE="Office Hours, Schedule Changes Closures"><U>Office Hours, Schedule Changes & Closures </U></A>   |   <A HREF="id18.htm" TARGET="_top" TITLE="Important Reminders"><U>Important Reminders</U></A>   |   <A HREF="id42.htm" TARGET="_top" TITLE="Insurance Coverages "><U>Insurance Coverages </U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE="Office Locations "><U>Office Locations </U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="Physicians "><U>Physicians </U></A>   |   <A HREF="id30.htm" TARGET="_top" TITLE="Office Policies Procedures"><U>Office Policies & Procedures</U></A>   |   <A HREF="id26.htm" TARGET="_top" TITLE="HIPAA"><U>HIPAA</U></A>   |   <B>Forms</B>   |   <A HREF="id35.htm" TARGET="_top" TITLE="Job Opportunities"><U>Job Opportunities</U></A>   |   <A HREF="id55.htm" TARGET="_top" TITLE="Open"><U>Open</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=180 BGCOLOR="#A0A0A4" TEXT="#080000" background="06ad4c00etbzwo.png"> <div> <I><B>ADULT & PEDIATRIC</B></I></div> <div> <I><B>ASTHMA,</B></I></div> <div> <I><B>IMMUNOLOGY &</B></I></div> <div> <I><B>ALLERGY</B></I></div> <div> <I>Phone: 630-652-0606</I></div> <div> <I>    Fax:  630-652-9900</I></div> </td> <td valign="top" height=390 BGCOLOR="#C0DCC0" TEXT="#080000"> <div> <I>Forms</I></div> <div> The following forms can be reviewed & downloaded  </div> <div> Note: Files are in PDF format. You must have ADOBE Arcobat software to display and save.</div> <bR> <div> HIPAA</div> <div> Click here... </div> <div> <B> <A NAME="new_patient_forms_package____"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <div> NEW PATIENT FORMS PACKAGE....</div> <div> Click here... <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="file://F:\CuteSite\NEWPAT-PACKAGE1.doc" TARGET="_top" TITLE="file://F:\CuteSite\NEWPAT-PACKAGE1.doc"><U> <a href="HTMLobj-272/NEWPAT-PACKAGE1.doc"><u>NEW PATIENT FORMS</u> </a>  </U></A></FONT></div> <bR> <div> ROI - Release of Information Form</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Click here... <A HREF="file://F:\CuteSite\ROI.pdf" TARGET="_top" TITLE="file://F:\CuteSite\ROI.pdf"><U> <a href="HTMLobj-285/ROI.pdf"><u>ROI-RELEASE OF INFO</u> </a>  </U></A></div> <bR> <bR> <bR> </td> </tr></table></body>