171 results found

• 503 *50318* R Authorization to Use and Disclose Protected Health ...

  Mental Health Therapy Records. □ Operative report(s) ... Substance Use Disorder Treatment Record(s) ... Information Management/Medical Record Department.

• Making Choices® Releasing medical records. • Determining which ...

  What is a healthcare agent? A healthcare agent is a person chosen by a loved one, family member, or friend to make healthcare decisions, including end-.

• Patient and Family Rights

  physician, to accept or refuse medical care as permitted ... medical record, in a timely fashion, and within the limits of ... information and records kept confidential.

• Opioid Use in Pregnancy EDUCATE patient. • ASK patient ...

  for reasons other than prescribed, or that weren't prescribed to patient. • Illegal ( illicit) drug use. (street or recreational drugs). Check DOPL and medical records ...

• Title Substance Use Disorder

  NOTICE TO CLINIC STAFF AND MEDICAL RECORDS:The information on this page is protected by special federal confidentiality rules (42 CFR Part 2), which ...

• Living Will and Durable Power of Attorney for Health Care

  medical and hospital records;. (2) Execute on my behalf any releases or other documents that may be required in order to obtain this information;. (3) Consent to ...

• Lumbar Spine Evaluation. Date

  Intermountain Healthcare 2013. Page 1 of 1. Patient Exam: Lumbar Spine Evaluation. Date: Time: Patient Name: M/F Age: Medical Record #:. Note: Findings that ...

• Your Medicare Annual Wellness Visit brochure or delay medical ...

  immunization records. • Any family health history you have, in as much detail as possible. • A complete ...

• Back Pain

  Patient Self History: Back Pain. CPM009a - 03/08/13 Patient and Provider Publications 801-442-2963. © Intermountain ... Medical Record # (for office use). 1.

• Suicide Prevention

  medical record(s), and/or consulting with family members and/or other ... Purpose : This tool enables you to estimate the patient's suicide risk through ...