FORMS
TELEMEDICINE CONSENT FORM
PATIENT REFERRAL FORM
Referral Form: https://form.jotform.com/221919109682158
HIPAA FORMS AND INFORMATION
HIPAA Consent Form: https://form.jotform.com/223097892178166
Patients' Privacy Rights: https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/consumers/consumer_rights.pdf
Sharing Information with Family and Friends: https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/consumers/sharing-family-friends.pdf
Privacy, Security, & EHR Records: https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/consumers/privacy-security-electronic-records.pdf
Your Health Information Rights (Infographics): https://www.healthit.gov/sites/default/files/YourHealthInformationYourRights_Infographic-Web.pdf
Video Links on HIPAA, Confidential and Privacy:
- Video 1 - Your Health Information, Your Rights: https://youtu.be/3WsRzlutBQk
- Video 2 -Your Health Information, Your Rights: https://youtu.be/y1BOc9HN0TA
- Video 3 - Your Health Information, Your Rights: https://youtu.be/bonloqeOrAg
MEDICARE INFORMATION
Medicare Rights and Protections: https://www.medicare.gov/Pubs/pdf/11534-medicare-rights-and-protections.pdf
Weight management/TREATMENT CONSENT
Weight Loss consent form: https://form.jotform.com/223098429980164
behavioral health assessments & consent forms
PHQ9 (Depression) Assessment: https://form.jotform.com/223098672334157
GAD-7 (Anxiety) Assessment: https://forms.gle/evT7xiJVZyFEafMD9
MDQ (Mood Disorder) Assessment: https://forms.gle/KeGx6buMasBbNGiQ8
Consent for Psychotropic Medications: https://na1.documents.adobe.com/public/esignWidget?wid=CBFCIBAA3AAABLblqZhDRjidTnQhF3pRVtI9ReXpidz-7V8rCCNP_qJdeIFf17-5Pgn834jQqtZPINTYkOKY*