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How I see it .... by Dr. Hartanowicz M.D.

It has been my experience that the majority of my patients by the time they see me feel as though they haven't been listened too, been rushed....not respected , some say... short comings of standard medicine continued

About conventional Cancer Therapy

Conventional cancer therapies may be effective, but Many cancer treatment specialists sometimes advise their patients to avoid nutritional supplements, believing that supplements will impair the effectiveness of their treatments.. of course this is not the case.

The idea that in order to destroy the cancer you must nearly kill the patient, is outmoded and counterproductive. Studies have demonstrated that cancers are much better resisted when immune integrity is maintained. When the patient and the patient’s immune system are supported, cancer therapies are much better tolerated, and may not have to be cut short because the patient becomes too sick to continue.

7 easy ways to improve your health

Start eating organic fruits and vegetables whenever possible. Studies continue to show organically-grown foods contain more vitamins and minerals and less chemicals than conventionally-grown food. Think about adding vitamins daily. Remember dietary supplements are NOT a substitute for good nutrition. continued

Thyroid problems / treatment

Alternative thyroid treatments like natural supplements can be used to avoid side effects. Natural thyroid medication has a holistic approach to the entire sphere of thyroid ...... continued

Holistic or 'Wholistic' treatment

Holistic or "wholistic" healing addresses all parts of the individual, not just the physical aspect of a person where manifested illnesses are most apparent. Holistic healing is not intended to serve as a band-aid or a one time fix. It is an ongoing journey of discovery in search of more answers and ultimately; living better, being healthier, and striving for wholeness.

Integrative medicine by an M.D. looks at the patient holistically and traditionally increasing effectiveness Integrative medicine looks at the patient holistically, and therefore may assess a patient in different ways in addition to traditional medical examinations and tests. These assessments look at the different systems of the body and are useful in telling us how the body is functioning, or in finding the root cause of your body imbalance or illness.

Conditions we see

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Supportive Cancer Care

We see many patients with cancer and we often seen patients who decline conventional therapy because they are afraid of the side effects. We offer protocols to improve tolerance to cancer therapy, to reduce the side effects and the risks of treatment complications. We can help you navigate through the sea of preventive, diagnostic, and conventional and integrative treatment choices for many different cancers. It is not necessary to face cancer with fear, uncertainty and powerlessness. We offer support, advice, encouragement, and optimism.

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Candida, Yeast/Fungal Overgrowth

Have Chronic Fatigue Syndrome, Fibromyalgia, or even sinusitis or spastic colon? You probably have overgrowth of yeast or Candida. Though poorly understood by most physicians, treating this underlying infection can have profound health benefits!

Dr.Stan's

articles

F.A.Q.'s

Insurance

Policies

IBS Oh my !

Irritable bowel and its many causes can often be greatly improved or cured. ..some of the common causes : lactose, wheat, gluten and multiple food allergies can be all aggravated by stress ...often heartburn , gas and bloating gone ! w/diet changes alone, ex. lower carbohydrate consumption !

rt 620

Alternative

Integrative

Holistic medicine

Naturally

New Patient forms

New Health Care Consumer Questionnaire

Patient Name ________________________________ DOB ____/____/________ Date ____/____/________

In order to best serve your medical needs, we ask that you complete the following questionnaire as completely as

possible. The Health Care Consumer (HCC) - Health Care Provider (HCP) relationship is a privileged

relationship built on trust and honesty. By completing and signing this form, you acknowledge that you understand

that any intentionally false information may seriously and adversely affect your health.

Patient Name ___________________________________________________________________ Gender M F

Last First Middle

Date of Birth (MM/DD/YYYY) ______/______/__________ Social Security Number _____ - _____ - _______

If the person completing this form is not the patient, please write your name, your relationship to the patient, and

why you are completing the form for this patient.

Name__________________________Relationship________________Reason_____________________

Reason For Visit _____________________________________________________________________

Patient’s Personal Contact Information (Address and Phone)

____________________________________ Home Phone _____________________________

____________________________________ Work Phone _____________________________

Emergency Contact (Address and Phone)

____________________________________ Home Phone _____________________________

____________________________________ Work Phone _____________________________

Insurance Information (Insurance Company, Policy Number, Contact Number)

____________________________________ Contact # _____________________________

Policy#______________________________ Fax (if known) _____________________________

Additional, or Secondary Insurance Company

____________________________________ Contact # _____________________________

Policy#______________________________ Fax (if known)______________________________

Have you completed a Living Will OR designated a Durable Power of Attorney for Health Care? Yes No

If yes, please provide a copy for your health care provider.

Do you have any religious or cultural beliefs that may impact your health care? Yes No

If yes, please describe

___________________________________________________________________________________

Methods of learning new material that I like best are:

Verbal Instruction Written Instruction Handouts Visual (Pictures, Videos, etc)

You Do You Do Not understand English well. The language you prefer _____________________

Level of education completed

<6th grade 6th – 8th grade 9th grade 12th grade 1-4 years college >4 years college

MB & RR 2008 e-medtools.com The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 1

New Health Care Consumer Questionnaire

Patient Name ________________________________ DOB ____/____/________ Date ____/____/________

Names and Phone Numbers for Health Care Providers (HCPs) from whom you are currently receiving care

(or have seen within the past 12 months), AND ANY Health Care Providers from whom you are obtaining

prescriptions.

_____________________________ Contact #__________________________

Please list all of the medications you are taking. Include over the counter medications, herbs & vitamins.

Medication Name Dose Last taken Medication Name Dose Last taken

___________________________________ ___________________________________

Please list and describe allergic reactions you have had to food, medications or insect stings.

Check if you are you allergic to Shellfish ___________ IV Contrast Dye __________ Penicillins __________

Please list Food, Medication or Insect Allergies Reaction

___________________________________ ___________________________________

MB & RR 2008 e-medtools.com The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 2

New Health Care Consumer Questionnaire

Patient Name ________________________________ DOB ____/____/________ Date ____/____/________

Please list your occupations. Include the length of time you performed in that role, and describe

your work responsibilities in that occupation. (Include military experience.)

Occupation Start Date Stop Date Responsibilities

________________ ________ _________ ____________________________________________

Have you ever been exposed to known cancer causing agents or inhalation hazards? Yes No

Examples: asbestos, paints, aniline dyes, chemicals, silica, etc.

If yes, please list types of exposure, time period exposed, and health problems experienced at time of exposure

Agent Start Date Stop Date Health problems resulting from exposure

________________ ________ _________ ____________________________________________

Please describe your hobbies.

_______________________________________ _______________________________________

Have you traveled, in the past 1 year? Yes No

If so, please describe where, when, and for how long you were there.

Travel destinations OUTSIDE the United States Dates spent at this destination

_______________________________________ _______________________________________

Travel destinations INSIDE the United States Dates spent at this destination

_______________________________________ _______________________________________

Do you exercise? Yes No If yes, describe how long and how often you exercise on average each week

__________________________________________________________________________________

In the past 12 months, have you fallen? Yes No If yes, how many times? ______

MB & RR 2008 e-medtools.com The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 3

If yes, have you ever broken bones, or sustained an injury, as a result of falling? Yes No

New Health Care Consumer Questionnaire

Patient Name ________________________________ DOB ____/____/________ Date ____/____/________

Do you have a history of smoking? Yes No If yes, ______ # packs per day X ______ for # years

Have you ever chewed tobacco? Yes No

Have you ever smoked pipes or cigars? Yes No If yes, how many cigars or bowls _____ perDay Week

Have you quit? If so, when. Yes No __________________________________________

Have you considered quitting? Yes No If yes, have you set a date to quit? Yes No

Have you tried quitting? Yes No If yes, what is the longest time period you quit smoking? ________

Do you have a history of alcohol use? Yes No If yes, specify _______ # drinks per Day Week

1 “drink” is equal to 12 oz. can of beer, 1.5 oz. liquor (80 proof) or 5 oz wine

Have you ever experienced a blackout, or loss of consciousness due to alcohol intake? Yes No

Have you ever needed to drink to prevent yourself from shaking, sweating, and becoming irritable? Yes No

Have you ever been arrested or ticketed for DUI (Driving Under the Influence)? Yes No

Have you been involved in any motor vehicle accidents in the past 12 months? Yes No

Do you use drugs for recreational purposes? Yes No

If yes, check all that apply Amphetamines Cocaine Marijuana Heroin Inhalants LSD

Method of delivery you chose Ingestion Injection Inhalation

How much would you use _________________________________________________________________

How long did you use drugs ______________________________________________________________

Have you quit? Yes No If so, when __________________________________________________

Have you ever taken drugs to prevent shaking, sweating and becoming irritable? Yes No

Have you ever had a problem with addiction to prescription pain medication or benzodiazepines? Yes No

If yes, specify when and which drugs. _____________________________________________

Are you sexually active? Yes No

If so, do you practice birth control of any kind? Yes No If yes, check below all that apply

Condoms Diaphragm IUD (Intrauterine Device) Birth Control Pills, Patches, Implants

How many sexual partners have you had in the past 1 year?

Have you ever had sex with a person who is the same gender as yourself, bisexual, or anyone who performs

sexual favors in exchange for money or drugs? Yes No

Have you EVER been diagnosed with a sexually transmitted disease (like syphilis, gonorrhea or HIV), or

were you exposed to a sexually transmitted disease during childbirth? Yes No

Do you have any tattoos or body piercings? Yes No

Have you received any transfusions of blood or blood products? Yes No

Describe your seatbelt use when you are driving, or a passenger in a vehicle

All the time Most of the time About half the time Rarely Never

Do you keep firearms in your place of residence? Yes No

If yes, are they kept in locked compartments, or do they have safety locks? Yes No

Can you perform your own hygiene, dressing, cooking and shopping needs independently? Yes No

Do you feel safe in your relationship? Yes No

MB & RR 2008 e-medtools.com The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 4

Have you ever been in a relationship where you were threatened, hurt or afraid? Yes No

New Health Care Consumer Questionnaire

Patient Name ________________________________ DOB ____/____/________ Date ____/____/________

Have you ever had the following exams?

If so describe when and why

PAP Smear Yes No ________________________________________________

Prostate Biopsy Yes No ________________________________________________

Mammogram Yes No ________________________________________________

Colonoscopy Yes No _______________________________________________

EGD (Esophageal endoscopy) Yes No ________________________________________________

EKG Yes No _______________________________________________

Cardiac stress test Yes No _______________________________________________

ECHO Yes No _______________________________________________

Chest x-ray Yes No _______________________________________________

CT “CAT” scan of chest Yes No _______________________________________________

Pulmonary function test Yes No _______________________________________________

EEG Yes No _______________________________________________

Bone density test Yes No ________________________________________________

Have you had any of the following vaccinations? Check all that apply, and specify when last received.

Yes No Influenza __________________

Yes No Pneumonia __________________

Yes No Tetanus __________________

Yes No BCG __________________

Yes No Varicella __________________

Yes No HPV (Gardasil) __________________

If you are female, have you ever been pregnant? Yes No If yes, please describe

Number of pregnancies? ______ Number of live births? ______ Number of miscarriages or abortions? _____

Age of onset of menstrual cycles? ______ Age of onset of menopause? ______ NA

Have you ever taken birth control pills, or used birth control patches or implants? Yes No

If yes, what did you take and for how long? ___________________________

Have you ever been on hormone replacement therapy? Yes No

If yes, what did you take and for how long? ___________________________

MB & RR 2008 e-medtools.com The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 5

Did you ever have an IUD? Yes No If yes, was it removed? If yes, when __________

New Health Care Consumer Questionnaire

Patient Name ________________________________ DOB ____/____/________ Date ____/____/________

Past Medical History Please check all that apply.

Adrenal Dysfunction

Yes

No Irregular Heart Rhythm

Yes

Alzheimer Yes No Kyphosis Yes No

Amyotrophic Lateral Sclerosis Yes No Liver Dysfunction Yes No

Anorexia or Bulimia Yes No Kidney Failure, or Dysfunction Yes No

Anxiety Disorder Yes No Malignancy If yes, describe below Yes No

Arteriovenous Malformations (AVMs) Yes No

Arthritis Yes No

Asthma Yes No Mania Yes No

Autoimmune Disease Yes No Muscular Dystrophy Yes No

Bipolar Disorder Yes No Myocardial Infarction (Heart Attack) Yes No

Bleeding Disorder Yes No Narcolepsy Yes No

Cataracts Yes No Obstructive Sleep Apnea Yes No

Cerebrovascular Accident (Stroke) Yes No Organ Transplant If yes, describe Yes No

Chemotherapy If yes, state when Yes No

Osteoporosis Yes No

Claudication Yes No Pancreatitis Yes No

Clotting Disorder Yes No Periodic Limb Movement Disorder Yes No

Congenital Heart Defects Yes No Peripheral Artery Disease Yes No

Coronary Artery Disease Yes No Personality Disorder Yes No

COPD Yes No Pituitary Dysfunction Yes No

Cystic Fibrosis Yes No Polycystic Ovarian Syndrome Yes No

Depression Yes No Pulmonary Artery Hypertension Yes No

Diabetes Yes No Pulmonary fibrosis Yes No

Dialysis Yes No Radiation Therapy If yes, explain Yes No

Eclampsia or Pre-eclampsia Yes No

Endocarditis Yes No Recurrent Infections Yes No

Endometriosis Yes No Restless Leg Syndrome Yes No

End Stage Renal Disease Yes No Sarcoidosis Yes No

Erectile Dysfunction Yes No Schizophrenia Yes No

Esophageal Dysfunction Yes No Scleroderma Yes No

Fibromyalgia Yes No Scoliosis Yes No

Gallstones Yes No Seizure Disorder Yes No

Gastritis or Gastric Ulcers Yes No Sickle Cell Yes No

GERD (reflux problems) Yes No Sjogren Yes No

Glaucoma Yes No Skin Disorders (Psoriasis, Acne) Yes No

Heart or Valve Defects Yes No Thalassemia Yes No

Hemochromatosis Yes No Thrombocytopenia Yes No

Hemorrhoids Yes No Thrombophilia Yes No

Hepatitis Yes No Transfusions Yes No

HIV or AIDS Yes No Tuberculosis Yes No

Hypertension Yes No If yes, have you been treated? Yes No

Hyperthyroidism Yes No Urinary retention or urgency Yes No

Hypotension Yes No Vasculitis Yes No

Hypothyroidism Yes No Visual defects Yes No

Inflammatory Bowel Disease Yes No Vocal cord dysfunction/paralysis Yes No

MB & RR 2008 e-medtools.com The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 6

New Health Care Consumer Questionnaire

Patient Name ________________________________ DOB ____/____/________ Date ____/____/________

Review of Systems In the last 6 months, have you experienced any of the following symptoms? Respond to each.

Constitutional Genitourinary

Weight Loss or Gain Yes No Blood in your urine Yes No

Appetite changes (increased or decreased) Yes No Menstrual changes Yes No

Fatigue, profound and impairs daily function Yes No Urinating that is painful or difficult Yes No

Fever Yes No Erection problems Yes No

Shakes/sweats from lack of alcohol or drug Yes No Vaginal discharge or bleeding Yes No

Eyes Musculoskeletal

Eye pain or drainage Yes No Broken bones Yes No

Visual changes Yes No Joint pain or swelling Yes No

Dry, irritated eyes Yes No Muscle aches Yes No

ENT/Mouth Muscle weakness Yes No

Ear pain or drainage Yes No Back pain Yes No

Frequent sinus infections Yes No Skin/Breasts

Hearing changes or loss Yes No Masses or lumps Yes No

Nosebleeds Yes No Nipple discharge Yes No

Dizziness Yes No Rashes or nonhealing ulcers Yes No

Respiratory Neurologic

Blood in your sputum Yes No Seizures Yes No

Chest tightness Yes No Coughing or choking with swallowing Yes No

Cough lasting >1 month, productive or not Yes No Excessive daytime sleepiness Yes No

Shortness of breath Yes No Extremity pain or burning sensations Yes No

Wheezing Yes No Hallucinations Yes No

Chest pain with inhalation or coughing Yes No Numbness or tingling Yes No

Cardiovascular Difficulty falling asleep, staying asleep Yes No

Chest pain or heaviness Yes No Endocrinologic

Palpitations Yes No Hair loss Yes No

Fainting or near fainting spells Yes No Frequent urination Yes No

Swelling of feet or legs Yes No Increased thirst Yes No

Shortness of breath lying flat in bed Yes No Heat or cold intolerance Yes No

Gastrointestinal Heme/Lymph

Abdominal pain Yes No Bleeding from gums or nose Yes No

Blood in your stool Yes No Unexplained bruising Yes No

Constipation Yes No Night Sweats Yes No

Diarrhea or Food Intolerance Yes No Swollen, painful lymph nodes Yes No

Heartburn or Indigestion Yes No Allergy/Immun

Vomiting or nausea lasting for >1 day Yes No Watery eyes Yes No

Swallowing difficulty Yes No Runny nose Yes No

Psych Food intolerance Yes No

Anxiety without clear explanation Yes No Frequent skin sores Yes No

Sadness lasting for days or weeks Yes No

Hearing voices Yes No

Thoughts of hurting yourself Yes No

Thought of hurting others Yes No

Fear of people, places or things Yes No

MB & RR 2008 e-medtools.com The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 7

✔

New Health Care Consumer Questionnaire

Patient Name ________________________________ DOB ____/____/________ Date ____/____/________

Please list all surgical procedures you have had. Please include surgeon and date of procedure.

_______________________________________ _______________________________________

Family Medical History Please list all known medical problems in your immediate family.

(Specify M=Mother, F=Father, B=Brother, S=Sister, So=Son, D=Daughter, GM=Grandmother, GF=Grandfather)

_________________ ______________________ ____________________ ___________________

Additional Information that you feel may be helpful for your health care provider to know.

__________________________________________________________________________________

Health Care Provider Notes

__________________________________________________________________________________

MB & RR 2008 e-medtools.com The information on this page was reviewed with the patient HCC Initials _____ HCP Initials _____ 8

Please print out and bring with your first visit

important ! ( may be mailed )

Stanley Hartanowicz M.D.

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This page was last updated: July 9, 2011

Dr Hartanowicz

in Spring 2010 issue

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pho 732-255-8880 ~ fax 732- 255-8885

Tom Calore Web design

DISCLAIMER: The information contained on this website has not been evaluated by The Food and Drug Administration. It is not meant to diagnose, treat, cure, or prevent any disease. Individuals suffering from any disease or illness, should consult with a physician or health care professional.

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Toms River Wellness Center, 10 Kettle Creek road suite A , Toms River NJ 08753

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conditions commonly seen