Patient Forms

Advance Directive 

Fill this out and give it to your doctor.  This form gives your doctor instructions about how to make decisions about your care.

• Advance Directives (English .pdf)
• Advance Directives (Spanish .pdf)

Medication Record

Print this and enter your medications.  Bring it with you to your doctor and hospital appointments.

• Medication Record (English .pdf)
• Medication Record (Spanish .pdf)

Personal Health Record

Print this and enter your health information and medications.  Be sure to bring it with you to your doctor and hospital appointments.

• Personal Health Record (English .pdf)
• Personal Health Record (Spanish .pdf)

Patient Bill of Rights

This form tells you how we protect your information and what you're entitled to from your healthcare provider.

• Patient Bill of Rights (English .pdf)
• Patient Bill of Rights (Spanish .pdf)
• Patient Guide & Bill of Rights 

HIPAA Noticy
of Privacy Practices

This form details our program to protect your privacy.

• HIPAA Noticy of Privacy Practices (English .pdf)
• HIPAA Noticy of Privacy Practices (Spanish .pdf)

Authorization
for Release of Information 

This form allows for your medical records to be released.

• Authorization for Release of Information Form