Jacksonville Nephrology
  • Home
  • Your Team
  • How We Help
    • Dialysis
    • Hyperkalemia
    • Hypertension
    • Hyponatremia
    • Kidney Disease
    • Nutrition
    • Proteinuria
    • Remote Patient Monitoring
    • Transplant Managment
    • Community Connections
  • Dialysis
  • Resources
    • Patient Info
    • Book List
  • Online Access
    • Connect Health Tracker
    • Healow App
    • Patient Portal
  • Contact Us
  • The Bean
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 Patient Information

Quick Links:

Welcome to Jacksonville Nephrology

Patient Portal
Connect to TEleVisit
We are here to help make your office visit as smooth as possible.  For your convenience please find PDF fillable forms below that you can fill out and print for your office visit.  Please fill in all requested information as accurately as possible to receive the most from your visit.  You can also log into your patient portal anytime to update demographic information, including address or insurance changes.   If you are unable to download the forms or log into the Portal, please arrive approximately 10 minutes prior to the scheduled appointment time to complete the forms.

Appointment Empowerment: Questions For and From your Team

We want all of our patients to be empowered and involved in their care. Our team loves to teach, learn, and grow together. When you come to our office, you can expect our team to conduct a thorough review of your chart and ask pertinent follow-up questions with you to ensure we provide the most efficient and effective care. Additionally, we encourage our patients to have questions for their care team to help them better understand their conditions, care plans, and policies and procedures. Below, we have some questions you can expect from our team as well as questions that can help facilitate a more productive appointment with Dr. Munjal. Please allow 24-48 hours for a response from our office for any messages or questions placed via phone or portal.
Questions to Expect From Our Team:
  1. Have you had any changes in your insurance information? (Copay, coinsurance, Member/Subscriber ID, Group Number, Carrier, etc.)
  2. Have you had any changes in your contact information? (Address, phone number(s), email address, etc.)
  3. Have you had any changes in your medications? (Additions, increases, reductions, discontinues, etc.)
  4. Have you had any labs or imaging completed since your last appointment with us? If so, where, when, and ordered by who?
  5. Has your Primary Care Physician (PCP) changed?
  6. Have you kept a log of your blood pressure readings?
  7. Have you had any falls recently?
  8. Have you had any new or different symptoms? (ex: dizzinesss, lightheadedness, headaches, changes in urination, etc.)
Questions to Ask Our Team:
  1. What can I do to manage my blood pressure?
  2. What are my next steps in managing my kidney disease?
  3. Can kidney diseases or hypertension lead to other conditions or illnesses?
  4. What dietary changes might I need to make?
  5. At what point do I need to consider dialysis or transplantation?
  6. What symptoms should I be looking out for to indicate changes in my blood pressure or kidney function?
  7. What are the potential risks and benefits of this treatment or care plan?
  8. Are there any alternatives to this treatment? What are my other options?
  9. What can I expect in the future with my kidney disease(s) and/or hypertension?
  10. What is the best case scenario? Worst case scenario? Most realistic? How can I manage my expectations?​​
  11. How might kidney diseases and/or hypertension affect my lifestyle?
  12. What are the potential side effects of proposed medication and/or treatment changes?

New Patient Documents

New Patient Form
File Size: 236 kb
File Type: pdf
Download File

Medical History Form
File Size: 233 kb
File Type: pdf
Download File

Medical Record Authorization
File Size: 160 kb
File Type: pdf
Download File

Healow Insights Consent
File Size: 220 kb
File Type: pdf
Download File

Current Patient Documents

Medical Record Authorization
File Size: 160 kb
File Type: pdf
Download File

Authorization to Share Medical Info with Family
File Size: 145 kb
File Type: pdf
Download File

Annual Chart Review
File Size: 274 kb
File Type: pdf
Download File

Healow Insight Consent
File Size: 220 kb
File Type: pdf
Download File

Miscellaneous Documents

Privacy Practices Policy
File Size: 210 kb
File Type: pdf
Download File

Blood Pressure Log
File Size: 208 kb
File Type: pdf
Download File

Medications List
File Size: 199 kb
File Type: pdf
Download File

Healow Insights Consent Information
File Size: 617 kb
File Type: pdf
Download File


You will need to download Adobe Acrobat Reader to use these forms.  Get the Adobe Acrobat Reader Here.
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Have Some Questions About Your First Visit?

Contact Us

Careers

Connect With Us

13241 Bartram Park Blvd., Suite 305
Jacksonville, FL  32258
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Tel: (904) 260-9898
​Fax: (904) 260-9891
Interested in joining our team?  Jacksonville Nephrology is dedicated to compassionate patient care through teaching and giving our team the tools needed to go above and beyond.  Learn more about current openings.  Learn More​
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Empowering Through Education.

  • Home
  • Your Team
  • How We Help
    • Dialysis
    • Hyperkalemia
    • Hypertension
    • Hyponatremia
    • Kidney Disease
    • Nutrition
    • Proteinuria
    • Remote Patient Monitoring
    • Transplant Managment
    • Community Connections
  • Dialysis
  • Resources
    • Patient Info
    • Book List
  • Online Access
    • Connect Health Tracker
    • Healow App
    • Patient Portal
  • Contact Us
  • The Bean