1111 - patientpop · 1111 40111 modern neurosurgery personal care ntopasii-rn 514039/3( . czi -.....

BRAIN AND SPINE SURGEONS OF ORANGE COUNTY Dear Valued Patient:

Your appointment is scheduled for

/ / at

with Dr.

Modern Neurosurgery

Personal Care The following are required for your upcoming appointment. Failure to complete these documents may result in your appointment being rescheduled.

1. Fill out completely and bring with you to you to your appointment. Please make sure all items are filled out on the patient forms.

2. You must have your MRI or CT films (the actual film or CD, not just the reports), and please bring all relevant medical records including past chemotherapy, surgeries, pathology, radiation, etc. reports. (exception: we have access to Hoag films)

3. Please bring your insurance cards with you. If you have an HMO, be sure to obtain authorization from your insurance provider prior to your appointment.

Finally, in order to provide the highest level of care, it is the policy of Brain and Spine Surgeons of Orange County to review scans and test results in our office. We cannot discuss results over the telephone. Please schedule an appointed time to speak with your doctor in person.

3900 West Coast Highway, Suite 300

Newport Beach, CA 92663

Phone 949.642.6787

Fax 949.642.4833

Patient signature:

Please print name:

Thank you, and we look forward to seeing you!

www.brainandspinesurgeons.com

Christopher Duma, MD, FACS

Brain Surgeon

Diplomate, American Board

of Neurological Surgery

Richard B. Kim, MD, MS

Neurosurgeon



Kristin E. Fasching, MS, PA-C

Physician Assistant

Elia Perez, RN, MSN, NP-BC

Nurse Practitioner

Shari Sharp, MMS, PA-C

Physician Assistant

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BRAIN AND SPINE SURGEONS OF ORANGE COUNTY

MAP AND DIRECTIONS

3900 West Coast Hwy, Suite 300, Newport Beach, CA 92663-3509 Hoag Conference Center/Neuroscience Institute (signage to be added soon)

e Christopher Duma, MD, FACS amyl

Brain Surgeon


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Nurse Practitioner


Physician Assistant

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Neurosurgeon



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Kristin Fasching, MMS, PA-C

Physician Assistant

3900 W. Coast Hwy, Suite 300 Newport Beach, CA 92663 Phone 949.642.6787 Fax 949.642.4833

Directions: 55 Freeway which ends and becomes Newport Blvd. Continue to PCH North (North on PCH. ) Right on Hoag Hospital Right on Hoag Drive Right into Parking Lot

South on PCH. Left at First Light after Superior is Hoag Hospital Right on Hoag Drive. Right into Parking Lot


520 Main Entrance

Emergency am — Contractor

Parking

Not Open toPublic- III

Lower Campus Entry

M -520 — 520 Superior Avenue • Hoag Rehabilitation Services (Suite 195)

Cardiac Rehabilitation, Occupational Therapy, Physical Therapy, Pulmonary Rehabilitation, Speech Therapy

• Hoag Wound Healing & (Suite 140)

Hyperbaric Medicine Center • Mary and Dick Allen Diabetes Center (Suite 150) • Physician Offices

HOAG HOSPITAL AND HOAG HEALTH CENTER-NEWPORT BEACH

Hoag Health Center — Newport Beach

(HHC-NB)

Plac

entia

Ave

nue

510 Main Entrance

HHC-NB Main Entry

94, 044

500 Main Entrance

Hoag Outpatient Imaging Entrance

538 Café located between Parking Structures A & 8.

Main Visitor Parking Structure

Hoag Hospital Main Entrance (Valet available)

Upper Campus Entry

Hoag Campus Buildings

A — 1501 Superior Avenue • Community Medicine

B — Charles & Kathryn Fishback - 330 Placentia Avenue

• Nautilus Healthcare Management Group

C — Newport Lido Tower I - 351 Hospital Road

D — Newport Lido Tower II - 361 Hospital Road

E — James Irvine Surgery Center

F — Hospital Main Entrance/ Sue & Bill Gross Women's Pavilion

G — Hospital South Entrance

H — Hoag Heart and Vascular Institute • Hoag Heart Valve Center

• Pacemaker and Arrhythmia

I — Patty & George Hoag Cancer Center

Hoag Conference Center V4€10— dr lire • Hoag Neurosciences Institute 11 -VAcor • Meeting Rooms 1-6

• OB Education

K — Marilyn Herbert Hausman Advanced Technology Pavilion • Radiology

• PET/CT, 3T MRI

• Gamma Knife Perfexion®

L — Donna and John Crean Child Care Center

Superior Avenue

a Way

Hoag Campus Patient and Visitor Parki

P1 — Community Medicine Parking

P2 — Fishback Building Employee Parking Only

— Lido Medical Building Parking

— Main Visitor Parking

— Cancer Center Parking

— Hoag Conference Center Parking

— Advanced Technology Pavilion Parking

— Child Care Center Parking

— Physicians & Staff Parking Alternate Patient & Visitor Parking

— Staff Parking

M-510 — 510 Superior Avenue • Hoag Blood Donor Services

• Hoag Outpatient EKG • Hoag Outpatient Imaging

CT Scan, Diagnostic Radiology, MRI Scan, Nuclear Medicine, Ultrasound

• Hoag Outpatient Laboratory • Hoag Pre-Admission Screening (PAS) • Judy & Richard Voltmer Sleep Center • Nautilus Healthcare

Management Group

HHC-NB Patient and Visitor Parking

A — HHC-NB Parking Structure A (Visitor/Patient Parking: Levels 1-2) (Staff Parking: Levels 3-5 only)

B — HHC-NB Parking Structure B (Physician Parking: Level 1) (Visitor/Patient Parking: Levels 2-41 (Staff Parking: Levels 3-4 only)

C — Visitor/Patient Parking Only

C

eHospital Road

Hoag Health Center - Newport Beach

M-500 — 500 Superior Avenue • CHOC Children's Speciality Services (Suite 140)

Allergy/Immunology, Cardiology, Gastroenterology, Genetics, Hematology, Neurology, Orthopedics,

Pulmonary and Urology

• GoldenHealth PLUS (Suite 360)

• Hoag Hospital Foundation (Suite 350) • Hoag Lung & Esophageal Center/

(Suite 305) Voice and Swallowing Center

• Hoag Urgent Care (Suite 160)

(Suite 130) (Suite 140) (Suite 100)

(Suite 110) (Suite 140) (Suite 280)

(Suite 290)

I I (,-CS-11

Pacific Coast Highway

DOB: Patient Name:

Christopher M. Duma M.D., P.C. Richard B. Kim, M.D., M.S. 3900 W. Coast Hwy, Suite 300 Newport Beach, CA 92663 (949) 642-6787 FAX (949) 642-4833

Original Date:

Dates Revised:

HEALTH HISTORY QUESTIONNAIRE All questions contained in this questionnaire are strictly confidential and will become part of your medical record

PERSONAL DATA

Phone: Relationship:

Name (Last, First, M.I.):

Marital status: ❑ Single

ETHNICITY:

PATIENT'S CURRENT

Address

City

111 M ❑ F DOB:

❑ Partnered ❑Married ❑ Separated ❑Divorced ❑ Widowed I Primary Language :

Weight:

Home Phone

Cell Phone

Height:

Social Security # Zip Code

Employer

Employer Address

City

Best number to call ❑ Home ❑ Cell ❑ Work

Email address:

EMERGENCY CONTACT

Na me:

SPOUSE / If Minor, PARENT

Occupation

Work Phone

Best time to call

Name of Spouse Social Security #

Spouse's Employer Cell Phone

Spouse's Employer Address

Work Phone

Occupation

City State Zip Code

INSURANCE DATA

Does the patient have insurance ❑ Yes ❑ No Is this a work related injury ❑ Yes ❑ No

PRIMARY Insurance Company: ❑ PPO ❑ HMO ❑ POS

Address: Insured Name

City, State Insured DOB:

Subscriber & Group # Insurance Phone #

SECONDARY Insurance Company: ❑ PPO ❑ HMO ❑ POS

Address: Insured Name

City, State Insured DOB:

Subscriber & Group # Insurance Phone #

What is the reason for your consultation today?

Diagnosis (if known) When did the symptoms begin?

REFERRING PHYSICIAN: Date of last physical exam:

Address Specialty

City Phone

State I Zip Code Fax:

1 of 4

Name the Drug Frequency Taken Strength

Year Reason Hospital

Primary Care Physician:

Address Specialty

Date of last physical exam:

City Phone

State Zip Code Fax:

Radiation Oncologist: Date of last physical exam:

Address Specialty

City Phone

State TZip Code Fax:

Neurologist: Date of last physical exam:

Address Specialty

City Phone

State Zip Code Fax:

Cardiologist: Date of last physical exam:

Address Specialty

City

I Zip Code

Phone

State Fax:

Other Physicians: Date of last physical exam:

Address Specialty

City Phone

State I Zip Code Fax:

DEEP BRAIN STIMULATOR PATIENTS:

Programming Physician: Phone:

PERSONAL HEALTH HISTORY

Current Medical Conditions:

Surgeries

Year Reason 1 Hospital

Other hospitalizations

List your prescribed drugs and over-the-counter drugs, such as vitamins and inhalers

DOB: Patient Name:

2 of 4

Are you currently taking any blood thinners; such as aspirin, Motrin or Coumadin? 0 Yes ❑ No

ALLERGIES to

Name the Drug

medications

Reaction You Had

Do you have an allergy to LATEX ❑ Yes ❑ No

FAMILY HEALTH HISTORY

Is there any family history of the following: Neurological disorders, Heart Disease, Cancer

AGE SIGNIFICANT HEALTH PROBLEMS AGE SIGNIFICANT HEALTH PROBLEMS

Father Children OM OF

Mother OM OF

Sibling OM OF

❑ M ❑ F

❑ M ❑ F

❑ M ❑ F

❑ M ❑ F

❑ M ❑ F

Grandmother Maternal

Grandfather Maternal

Grandmother Paternal

Grandfather Paternal

taken steroids Have you ever (such as Decadron, dexamethasone, Medrol, hydrocortisone) ❑ Yes ❑ No

for your CURRENT condition:

What medication Dose

PERSONAL SAFETY

How long?

What medication Dose How long?

HEALTH HABITS AND

PE CHECK APPROPRIATE BOX IN EACH SECTION BELOW: GENERAL HEATLH QUESTIONS Do you drink alcohol?

Have you had cancer?

❑ Yes ❑ No What kind? How many drinks per week?

❑ Yes ❑ No If so, what type of cancer?

Do you use tobacco? ❑ Yes ❑ No Did you ever smoke?: Years: Or year quit:

Cigarettes-pks/day Chew- #/day Pipe - #/day Cigars #/day

Do you currently use recreational or street drugs? ❑ Yes ❑ No

Have you ever had radiation therapy? ❑ Yes 111 No To what part of the body? When?

CARDIOVASCULAR r

Hypertension

Pain or shortness of breath when walking 2 blocks or climbing 1 flight of stairs

Coronary Artery Disease

Cardiomyopathy

Arrhythmias i.e. A-Fib

Heart Attack - Date

Rheumatic Fever

Heart murmur ❑ Yes ❑ No

❑ Yes

❑ Yes

❑ Yes

❑ Yes

❑ Yes ❑ No

❑ Yes ❑ No

❑ Yes ❑ No

❑ No

❑ No

❑ No

❑ No

Angina/Chest Pain ❑ Yes ❑ No

Congestive Heart Failure ❑ Yes ❑ No

High Cholesterol _ _ _ _ _ ❑ _____ ❑

Yes

Yes

❑

❑

No _ _ No Poor Circulation in lower extremities

Family history of heart disease Age of onset Father Mother ❑

0

Yes

Yes

❑

❑

No

No

Siblings

Carotid Artery Disease

Heart Valve problems ❑ Yes ❑ No

Pacemaker, what brand ❑ Yes ❑ No PULMONARY

Pneumonia - Date

Sleep Apnea ❑ Yes ❑ No

Do you use a C-Pac Machine ❑ Yes ❑ No Chronic Cough ❑ Yes ❑ No

❑ Yes

❑ Yes

❑ Yes

❑ No

❑ No

❑ No

Asthma -----

COPD/Bronchitis/Emphysema (cirde)

DOB:

Patient Name:

3 of 4

DOB:

Patient Name:

Tuberculosis

Blood clots in lungs or legs

❑

❑

Yes ❑ No

No

Oxygen Use ❑ Yes ❑ No

Yes ❑

GASTROINTESTINAL GENITOURINARY

Hiatal Hernia

Ulcers/GERD/Gastric Reflux (circle)

❑

❑

Yes

Yes

❑

❑

No

No

Urinary Track Infections

Kidney Stones

❑

❑

Yes

Yes

❑

❑

No

No

Gallstones ❑ Yes ❑ No Prostate Disease ❑ Yes ❑ No

Liver Disease ❑ Yes ❑ No Penile Prosthesis ❑ Yes ❑ No

Hepatitis A, B, or C

HEMATOLOGIC

❑ Yes ❑ No Dialysis ❑ Yes ❑ No

ENDOCRINE

Anemia ❑ Yes ❑ No Diabetes ❑ Yes ❑ No

Bleeding Disorders ❑ Yes ❑ No Hypo/Hyperthyroidism ❑ Yes ❑ No

Blood Transfusions ❑ Yes ❑ No Hypoglycemic ❑ Yes ❑ No

Easy Bruising ❑ Yes ❑ No ❑ Yes ❑ No

StokerrIA's Date: ❑ Yes ❑ No Numbness ❑ Yes ❑ No

Multiple Sclerosis

Myasthenia Gravis

❑

❑

Yes

Yes

Yes

Yes

❑

❑

❑

❑

No

No

Muscle Weakness

Headache

❑

❑

Yes

Yes

❑

❑

No

No

Paralysis

Seizures

❑

❑

No

No

Fainting ❑ Yes ❑ No

PAIN Yes ❑ No Chronic Pain Treatment ❑ Yes ❑ No Rheumatoid arthritis ❑

Back/Neck Pain ❑ Yes ❑ No Osteoarthritis ❑ Yes ❑ No

❑ Yes ❑ No Artificial Joints Location ❑ Yes ❑ No

GENERAL HEALTHCARE

❑ Cancer Location: Yes ❑

❑

❑

No Have you had:

Radiation Therapy

Chemotherapy

❑

❑

Yes

Yes

No MMR Vaccine ❑ Yes ❑ No

No Flu Vaccine - Date: ❑ Yes ❑ No

Immune Deficiency ❑ Yes ❑ No Pneumonia Vaccine - Date: ❑ Yes ❑ No

No Measles/Mumps/Rubella (circle) ❑ Yes ❑ No TB Skin Test ❑ Positive ❑ Negative ❑ Unknown ❑ Yes ❑

Chicken Pox

Any possibility of being pregnant

❑

❑

Yes

Yes

❑

❑

❑

No

No

No

Patient's Dominant Hand: ❑ Right ❑ Left

WOMEN ONLY

❑ — Date of last menstrual period

No History of Malignant Hyperthermia (MH) ❑ Yes Hysterectomy Date Yes ❑

Any history of bleeding problems ❑ Yes ❑ No Family history of anesthesia problems or MH (circle) ❑ Yes ❑ No

Patient signature: Date: (If patient is a minor, Parent or Guardian signature)

4 of 4


Patient's Name:

RECORDS RELEASE AUTHORIZATION

r I wri Alit

Modern Neurosurgery

Personal Care

Medical Record #

Birth Date: Male Female

Telephone Number:

I, the undersigned, hereby authorize Christopher Duma, M.D. P.C., and Richard Kim, M.D., M.S., to obtain the following information:


Brain Surgeon




Neurosurgeon




Nurse Practitioner


Physician Assistant


Physician Assistant

Medical Information

Pathology

Radiology

From the following physicians:

(Name)

Please send records to:

(Address)

Christopher M. Duma, M.D., P.C. Richard B. Kim, M.D., M. S. 3900 W. Coast Hwy., Suite 300 Newport Beach, CA 92663 (949) 642-6787

(949) 642-4833 3900 W. Coast Hwy, Suite 300 Newport Beach, CA 92663 Or Fax records to: Phone 949.642.6787 Fax 949.642.4833

(initials)

(initials)

(initials)

(Phone)

(Phone) (Name)

(Address)

(Patient Signature)

(If patient representative, sign and state relationship)

(Date)

(Date)


PATIENT PHARMACY INFORMATION DRAIN AND SPINE SURGEONS OF ORANGE COUNTY

Modern Neurosurgery

Personal Care


Brain Surgeon




Neurosurgeon

Dip/ornate, American Board



Physician Assistant


Norse Practitioner


Physician Assistant



Phone 949.642.6787

Fax 949.642.4833

Patient Name:

Patient DOB:

Allergies:

Patient Tel tt:

Pharmacy Name:

Address:

Telephone II:

www.brainandspinesurgeons.cop ,


Modern Neurosurgery

ersonnl Care

Ch

Relationship: Phone:

2. Relationship: Phone:

ristopher Duma, MD, FAGS 3. Relationship: Phone:

Due to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) we are no longer allowed to release patient information to anyone other than the patient, unless the patient gives specific written authorization. In the space below, list any family members that you give your permission for the Doctor or nurse to discuss your medical information. This permission can be rescinded at any time per the patient's verbal or written request.

Authorization to Release Information to Family Members

DOB: Patient Name:

Brain Surgeon

Authorization to Identify Self with Messages (Authorization to leave messages on recorder)

Dip! mate, American Board



My signature below authorizes Dr. Duma or Dr. Kim and/or his staff to identify themselves from the doctor=s office when calling to leave a message regarding my appointments, results, referrals or other medical information on any answering device or with another person answering the phone.

Patient/Guarantor (signature)

No - I do not authorize this (signature)

Neurosurgeon

Diploma e, American Board



Physician Assistant


Nurse Practitioner Notification of Insurance Information Changes


Physician Assistant



Phone 949.642.6787

Fax 949.642:4833

We are committed to providing you with the best possible care. If you have insurance, we are happy to submit your claims for processing. However, please be advised that you are responsible for payment of services should you fail to notify us before services are rendered, of any changes in your insurance information. This would include changes in your medical group or IPA, health plan, primary physician, referring physician, benefits, and eligibility. Pleose submit to our office your updated insurance cord to inform us of any changes in your insurance. Remember, your notification of any changes in your insurance must be submitted to us before services are rendered.

IN SIGNING BELOW, YOU ARE STATING THAT YOU HAVE 1) READ AND UNDERSTAND THE INFORMATION CONTAINED HEREIN 2) WILL PRESENT CURRENT INSURANCE CARD AT TIME OF APPOINTMENT

Patient/Guarantor Signature

Patient/Guarantor printed Name

Date:

www.brainandspinesurgeons corn

NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW

YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

The Health Insurance Portability & Accountability Act of 1996 ("HIPAA") is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information.

As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.

We may use and disclose your medical records only for each of the following purposes: treatment, payment and health care operations.

• Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. An example of this would include a physical examination.

• Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. An example of this would be sending a bill for your visit to your insurance company for payment.

• Health care operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. An example would be an internal quality assessment review.

We may also create and distribute de-identified health information by removing all references to individually identifiable information.

We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer:

• The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.

• The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.

• The right to inspect and copy your protected health information.

• The right to amend your protected health information.

• The right to receive an accounting of disclosures of protected health information.

• The right to obtain a paper copy of this notice from us upon request.

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.

This notice is effective as of April 14, 2003, and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from this office.

You have recourse if you feel that your privacy protections have been violated. You have the right to file a formal, written complaint with our office or with the Department of Health & Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.

Please contact us for more information, by asking to speak to our Privacy Officer or for written inquiries, note "Attention Privacy Officer'.

For more information about HIPAA or to file a complaint:

The U.S. Department of Health & Human Services Office of Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201 (202) 619-0257 Toll Free: 1-877-696-6775

ITCM 07140041390a 0 MAY 2002

DOB: Patient Name:


re: Modern Neurosurgery

Personal Care


Brain Surgeon




Neurosurgeon




Nurse Practitioner


Physician Assistant


Physician Assistant

ACKNOWLEDGEMENT OF NOTICE OF PRIVACY PRACTICES

I have received a copy of the Brain and Spine Surgeons of Orange County Notice of Privacy Practices

Signature of Patient or Representative Date

Relationship to Patient

Printed Name

Signature of Witness Date

If the patient does not sign this acknowledgement, please identify what effort was made to obtain an acknowledgement:

❑ Patient given a copy of the Notice but refused to sign form.

❑ Patient unable to sign acknowledgement related to: Emergency treatment situation Mentally Incompetent Language Barrier

Other 3900 W. Coast Hwy, Suite 300


Phone 949.642.6787 ❑ Other explanation: Fax 949.642.4833

Signature of Provider Employee Date


MESSAGE TO OUR PATIENTS ABOUT ARBITRATION

The attached contract is an arbitration agreement. By signing this agreement, we are agreeing that any dispute arising out of the medical services you receive is to be resolved in binding arbitration rather than a suit in court. Lawsuits are something that no one anticipates and everyone hopes to avoid. We believe that the method of resolving disputes by arbitration is one of the fairest systems for both patients and physicians. Arbitration agreements between health care providers and their patients have long been recognized and approved by the California courts.

By signing this agreement, you are changing the place where your claim will be presented. You may still call witnesses and present evidence. Each party selects an arbitrator (party arbitrators), who then select a third, neutral arbitrator. These three arbitrators hear the case. This agreement generally helps to limit the legal costs for both patients and physicians. Further, both parties are spared some of the rigors of trial and the publicity that may accompany judicial proceedings.

Our goal, of course, is to provide medical care in such a way as to avoid any such dispute. We know that most problems begin with communication. Therefore, if you have any questions about your care, please ask us.

MESSAGE TO OUR PATIENTS REGARDING INSURANCE BILLING

We are happy to bill your insurance carrier for services rendered by Brain and Spine Surgeons of Orange County. In order to do his, we must have your current insurance card. We will make a photocopy and submit a claim to your insurance company. At the time of service we will ask for your co-payment.

If you are covered by insurance and do not have a card yet, we require a statement from your insurance company, agent or employer verifying coverage. The information needed is: I) Name of Insurance Company, claims address and phone number. 2) Subscriber Name and ID number. 3) Group Name. 4) Effective date of coverage. 5) Amount of deductible and amount met to date.

If this information is not available, we will be happy to see you on a CASH basis and provide you with the necessary information to bill your insurance yourself.

It is also the patient's responsibility to confirm with their insurance carrier that Dr. Duma and Dr. Kim are covered under the patient's insurance company's plan. Your insurance company may require prior authorization for you to see Dr. Duma and Dr. Kim. Please contact your insurance carrier if you have any doubts about the coverage for your visit today.


II 1 II AI Modern Neurosurgery

Personal Care


Brain Surgeon




Neurosurgeon

Diplomote, American Board



Nurse Practitioner


Physician Assistant


Physician Assistant

3900 W. Coast Hwy, Suite 300

Newport Beach, CA 92663 Phone 949.642.6787

Fax 949.642.4833


1111 - patientpop · 1111 40111 modern neurosurgery personal care ntopasii-rn 514039/3( . czi -.....

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