| Patient Form Name |
|
Description |
New Patient Registration |
|
Completed by parent/guardian to register a new patient with a CCP Practice |
Request of Release of PHI (Medical Records) to a CCP Practice |
|
Completed by parent/guardian to request to transfer PHI to a CCP Practice |
Designated Representative for Medical Consent |
|
Completed by a parent/guardian to authorize another person to seek medical treatment for their child, i.e., grandparent, aunt etc. |
Notice of Privacy Practices and Summary |
|
Describes how medical information may be used and disclosed and how you get access to your medical information |
Vaccine Information Statements |
|
Vaccine Information Statements (VISs) are information sheets produced by the Centers for Disease Control and Prevention (CDC) that explain to vaccine recipients, their parents, or legal representatives both the benefits and risks of a vaccine. |
Request of Release of PHI (Medical Records) from a CCP Location |
|
Completed by parent/guardian to request medical record release from a CCP practice to another physician/practice. Please select from the list of practices below.
|
