IMPORTANT DOCUMENTS

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FORM 1 CONSENT TO TREATMENT

Important document regarding your voluntary decision to have a doctor-patient relationship with PHA-Adult Medicine.

FORM 2: PAYMENT POLICY

Important document regarding your financial obligations for services received at PHA-Adult Medicine

FORM 3: PATIENT CONSENT TO USE AND DISCLOSURE

Important document to direct PHA-Adult Medicine how to disclose information to patients

FORM 4: AUTHORIZATION TO RELEASE MEDICAL RECORDS TO PHA-ADULT MEDICINE

Complete this document and forward it another individual or organization to get medical records released to PHA-Adult Medicine.  This is good to request records from previous primary care providers.

FORM 5: NOTICE OF PRIVACY POLICY

Important document regarding Notice of Privacy, HIPAA and how your personal health information is handled and safeguarded.

FORM 6 : MEDICAL MARIJUANA CONSENT

Please complete consent form and bring to office for your medical marijuana certification session. Leave all or any questions incompleted if you have any questions before signing.

 

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