New patient form

Access to PHI

Access to PHI (English)

Access to PHI (Spanish)

Access to PHI (Creole)

New Patient Form

New Patient Form (English) 

New Patient Form (Spanish)

New Patient Form (Creole)

General Consent Form

General Consent Form (English)

General Consent Form (Spanish)

General Consent Form (Creole)

HIPAA Privacy Authorization Form

HIPAA Privacy Authorization Form (English)

HIPAA Privacy Authorization Form (Spanish)

HIPAA Privacy Authorization Form (Creole)

Authorization to Release or Request Protected Health Information

Authorization to Release or Request Protected Health Information (English)

Authorization to Release or Request Protected Health Information (Spanish)

Authorization to Release or Request Protected Health Information (Creole)

Notice of Privacy Practices

Notice of Privacy Practices (English)

Notice of Privacy Practices (Spanish)

Center Privacy Notice

Center Privacy Notice (English)

Center Privacy Notice (Spanish)

Center Privacy Notice (Creole)

Provider History Form

Provider History Form (English)

HIE Patient Fact Sheet

HIE Patient Fact Sheet (English)