Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility. Autorización De HIPAA Para Divulgar Información Del Paciente

Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento

Patient Designated Contacts (PDF) - Patients are encouraged to complete and return the Patient Designated Contacts Form but it is not required. Contactos designados del paciente

Informed Consent for Telehealth Services (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology. Consentimiento informado para servicios de telesalud

Health Information Exchange (HIE) Opt-Out (PDF) - This form allows patients to opt out of sharing their PHI via the Health Information Exchange (HIE). The HIE securely shares patient information electronically among a network of healthcare providers, such as physicians, hospitals, labs, and pharmacies. Formulario de solicitud de exclusión voluntaria de Privia HIE