FormsJose Gregorio Galib2019-11-20T23:43:29+00:00

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FORMS

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Release of Medical Information HIPAA

1.-Autorizacion-para-divulgar-informacion-medica-de-conformodidad-con-HIPPA

Patient Registration Form

2-Patient-Registration

Health Care Proxy (DOH-1430)

3-Health-Care-Proxy-(DOH-1430) (1)

DMC Email and messaging authorization

4-DMC-Email-and-Messaging-Authorization (1)

DMC Healthix Consent

5-DMC-Healthix-Consent (1)

Consent to discuss treatment

6-Consent-to-Discuss-Treatment (1)

Medical Examination and Vaccination

7-Medical-Examination-and-Vaccination (1)

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