病人形式

表格可透过“ 病人门户 or you can print them from our website and bring them with you to your appointment.

病人形式

Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, 公司, 机构, 或设施. Autorización De HIPAA Para Divulgar Información Del Paciente

Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, 通信(电话, 电子邮件, 和发短信), 以及经济责任协议. Autorización y Consentimiento Para el Tratamiento

首选联系人(PDF) - Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos

虚拟访问政策(PDF) - This policy describes the process for the documentation, 维护, and transmission of information using virtual visit technology.

办公室的政策

财务政策(PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations. Política Financiera (PDF)

私隐实务通知(PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. 请仔细阅读本通知. Aviso de prácticas de privacidad (PDF)

HIPAA隐私声明