New Jersey Endocrine Assoc

Due to the COVID-19 pandemic, TELEMEDICINE is now available
through our patient portal.  Please call extension 104, to be enrolled.

​Phone 732-736-1000
​Fax 732-736-8811
Patient Portal: 
​https://health.healow.com/njendos

  • Home
  • Forms
    • Notice of HIPAA Privacy
    • Patient Registration Form
    • 1st Visit Form
    • Release of Medical Records
    • Blood Glucose Diary 2 Weeks
    • Blood Glucose Level 1 Month
    • Meaningful Use Form
  • Meet the Doctors
    • Oscar T. Ortiz, MD
    • Ronald B. Villanueva, MD
    • Paula Brunetti Imai, NP
  • Office Policy
  • Accepted Insurance
  • Our Locations
    • Toms River Location
    • Brick / Lakewood Location
  • Meet The Staff
  • Contact Us
  • New Page
  • Registration Page
  • New Page
Forms

General

Office Policy
Due to the extreme volume of patients and patients’ needs, the following policies have become necessary to help us better serve all our patients. Please click 'download' to see and/or print our Office Policy.
 
Download


Notice of HIPAA Privacy
We understand that your medical information is private and confidential. Please click 'download' to see and/or print our Notice of HIPPA Privacy.
Download
HIPAA Signed Form
Download


Patient Registration Form
This file is our Patient Demographic Information Sheet and is required for new patients. Please click 'download' to see and/or download the file.
Download


First Visit Form
This file is our First Visit Patient form and will aid you and your doctor if filled out before your first visit. Please click 'download' to see and/or download the file.
Download


Release of Medical Records
This file is a request for a release of medical records. Please click 'download' to see and/or download the file.

Download
Meaningful Use Requirements
Download

Self Monitoring Blood Glucose Diary

Oscar T. Ortiz, MD
Please click the 'download' button, and then print out the document. This specific document is for patients of Oscar T. Ortiz, MD.
Download


Ronald B. Villanueva, MD
Please click the 'download' button, and then print out the document. This specific document is for patients of Ronald B. Villanueva, MD.
Download


Leslie Taguba-Madrid, MD
Please click the 'download' button, and then print out the document. This specific document is for patients of Leslie Taguba-Madrid.
Download
Home    |    Forms    |    Meet the Doctors    |    Office Policy    |    Accepted Insurance    |    Our Locations

1163 Rt. 37 West, Suite A-1 
Toms River
732-736-1000
1255 Route 70, Suite 20 N
Lakewood
732-736-1000

©2020 Oscar T. Ortiz MD PC, all rights reserved.
Designed by Walsh Internet Marketing
Home
Forms
Meet the Doctors
Office Policy
Accepted Insurance
Our Locations

1163 Rt. 37 West, Suite A-1 
Toms River
732-736-1000
56 Schoolhouse Rd. Suite A-2
Whiting
732-736-1000
1255 Route 70, Suite 20 N
Lakewood
732-363-4770

©2014 Oscar T. Ortiz MD PC, All Rights Reserved.
1163 Rt 37 West Suite a-1, Toms River, NJ 08755. (732) 736-1000
Designed by Walsh Internet Marketing

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