Rhode Island Medicine,Inc
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PATIENT FORMS
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CURRENT PATIENT
PATIENT
YOUR INFORMATION
OF DR. RAMIREZ
If this is your first visit, please print this form, fill it out and bring it to your appointment.
 
If you are a current patient and need to update your information (Tel/Address/Insurance/Name change), please print this form, fill it out bring it to your appointment.
 
If your are having an annual physical with Dr. Ramirez, please print this form, fill it out and bring it to your appointment.
Click here to download
 
Click here to download
 
Click here to download Dr. Ramirez
New Patient Form
 
Patient Update Information Form
 
Current Patient Annual Physical Form

NOTE: All Patient forms are PDF format

Rhode Island Medicine is a group of Internal Medicine Physicians providing coordinated and integrated office-based general medical care to adults. Located in Woonsocket, RI, we are close to Cumberland, Lincoln, North Smithfield in Rhode Island and Blackstone, Franklin, Bellingham in Massachusetts.
Our physicians are experts in preventive health care and common medical issues including Diabetes, Hypertension (High Blood Pressure) and Hypercholesterolemia (High Cholesterol).
Rhode Island Medicine participates with major insurers including Medicare, BlueCross BlueShield, Tufts, Aetna, Cigna, Tricare and United Healthcare.
 
This website is for basic demographic information only.
It is not intended for any general or specific medical advice. If you are facing a medical emergency, please call 911 or go to the nearest emergency services location. If you believe you have a medical issue, please contact a health care professional.
Rhode Island Medicine, Inc. - Dr. Irfan Ahmad - Dr. Basilia Ramirez (401) 765-4100
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Updated
April 10, 2014
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