Forms

Little Boy Playing Doctor

Vaccine Information Sheets (VIS)

Pneumovax 23 PPV

PRINTABLE FORMS

TELEMEDICINE CONSENT FORM

MEDICAL RECORDS RELEASE FORM

Authorization to Release PHI (Protected Health Information)

ORGANIZATION AND SCHOOL FORMS

SLPA General Exam Form

Missouri State Preschool Form

HIPAA FORMS AND POLICIES

Notice of Privacy Practices

HIPAA Consent Form

Medical / Financial Information Disclosure Policy

Medical / Financial Information Disclosure Form

GENERAL FORMS AND POLICIES

Financial Policy

Split Vaccine Charge Form

Over 18 HIPAA Form

16 - 17 year old consent to treat form

Parent Vaccine Consent

EAR PIERCING INFORMATION

Ear Piercing Handout