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FORMS
Pediatric Forms:
Authorization to Release or Obtain Medical Information
(PDF)
Patient Demographics
(PDF)
Consent to Treat
(PDF)
Patient History
(PDF)
PCPFM Office Policy
(PDF)
PCPFM Financial Policy
(PDF)
PCPFM HIPPA Policy
(PDF)
Receipt of Notice of Privacy Practices Written Acknowledgement Form
(PDF)
Adult Forms:
For patient more than 21 years of age.
Authorization to Release or Obtain Medical Information
(PDF)
PCPFM Office Policy
(PDF)
PCPFM Financial Policy
(PDF)
PCPFM HIPPA Policy
(PDF)
Patient History
(PDF)
Patient Demographics
(PDF)
Receipt of Notice of Privacy Practices Written Acknowledgement Form
(PDF)
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