Newborn Patient

• Patient – Minor Registration Form
• Newborn Form
• No-Show – Cancellation Acknowledgement Form – Medicaid (if applicable)
• No Show – Cancellation Acknowledgement Form – Private Insurance (if applicable)
• Notice of Privacy Practices for Protected Health Information and policy revised 11-11-2022 #2
• Written Ack Form – HIPAA Notice and Policy revised 11-11-2022
• CPAM – HIPAA Authorization to Release or Obtain Health Information 2-6-23

Minor Patient

• Patient – Minor Registration Form
• No-Show – Cancellation Acknowledgement Form – Medicaid (if applicable)
• No Show – Cancellation Acknowledgement Form – Private Insurance (if applicable)
• Notice of Privacy Practices for Protected Health Information and policy revised 11-11-2022 #2
• Written Ack Form – HIPAA Notice and Policy revised 11-11-2022
• CPAM – HIPAA Authorization to Release or Obtain Health Information 2-6-23

Adult Patient (18 years or older)

• Patient – 18 years or older Registration Form
• No-Show – Cancellation Acknowledgement Form – Medicaid (if applicable)
• No Show – Cancellation Acknowledgement Form – Private Insurance (if applicable)
• Notice of Privacy Practices for Protected Health Information and policy revised 11-11-2022 #2
• Written Ack Form – HIPAA Notice and Policy revised 11-11-2022
• CPAM – HIPAA Authorization to Release or Obtain Health Information 2-6-23

Medical Release Form

• CPAM – HIPAA Authorization to Release or Obtain Health Information 2-6-23

Individual Forms

• Patient – Minor Registration Form
• Patient – 18 years or older Registration Form
• Newborn Form
• No-Show – Cancellation Acknowledgement Form – Medicaid (if applicable)
• No Show – Cancellation Acknowledgement Form – Private Insurance (if applicable)
• Notice of Privacy Practices for Protected Health Information and policy revised 11-11-2022 #2
• Written Ack Form – HIPAA Notice and Policy revised 11-11-2022
• CPAM – HIPAA Authorization to Release or Obtain Health Information 2-6-23