Applied Clinical/Private Practice

Forms (click to download)

https://docs.google.com/document/d/1Bzplx_NfBKCoWBKjPMCKUaibvMvPlyT_/edit?usp=sharing&ouid=110824223630179646730&rtpof=true&sd=true

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AUTHORIZATION TO REQUEST INFORMATION

https://docs.google.com/document/d/1WnTCNUaSjWabcBLPKBK_fHi_ANPrqmoy/edit

AUTHORIZATION TO RELEASE INFORMATION

https://docs.google.com/document/d/18jK-8eSYlpDcEhjKftSxlqLLMlCHvWBH/edit

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https://docs.google.com/document/d/e/2PACX-1vSugq3UJo0yiM4rGPniI2MaKOxDJoNpzs2eH1ANoZ0Vb6-laaymx_fPbVzGaYH63moUqsm3xx469fA4/pub

Applied Clinical/Private Practice

Forms (click to download)

NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION

https://docs.google.com/document/d/1RZD9XaDZzTYMXLVXQJPhO4jfFeNPX6EN/edit

REGISTRATION FORM 07 03 15

https://docs.google.com/document/d/1Bzplx_NfBKCoWBKjPMCKUaibvMvPlyT_/edit?usp=sharing&ouid=110824223630179646730&rtpof=true&sd=true

AUTHORIZATION TO REQUEST INFORMATION

https://docs.google.com/document/d/1WnTCNUaSjWabcBLPKBK_fHi_ANPrqmoy/edit

AUTHORIZATION TO RELEASE INFORMATION

https://docs.google.com/document/d/18jK-8eSYlpDcEhjKftSxlqLLMlCHvWBH/edit