Forms

Read-only PDF/Word Docs (click to download): 

Medical Visit Planner

Mosaic Health Medical Visit Planner

New Patient Packet—English

New Patient Packet

New Patient Check List

Authorization for Treatment

Authorization for the Treatment of Minors

Authorization to Release Protected Health Information

Authorization to Obtain Protected Health Information

New Patient Packet—Spanish

New Patient Packet—Spanish

Authorization for Treatment—Spanish

Authorization for the Treatment of Minors—Spanish

Patient Privacy Notice- Spanish

Authorization to Release Protected Health Information—Spanish

Authorization to Obtain Protected Health Information—Spanish

New Patient Packet—Nepali

New Patient Packet—Nepali

Authorization for Treatment—Nepali

Authorization for the Treatment of Minors—Nepali

Patient Privacy Notice-Nepali

Authorization to Release Protected Health Information—Nepali

Authorization to Obtain Protected Health Information—Nepali

New Patient Packet—Arabic

New Patient Packet—Arabic

Authorization for Treatment—Arabic

Authorization for the Treatment of Minors—Arabic

Patient Privacy Notice- Arabic

Authorization to Release Protected Health Information—Arabic

Authorization to Obtain Protected Health Information—Arabic

New Patient Packet—Karen

New Patient Packet—Karen

Authorization for Treatment—Karen

Authorization for the Treatment of Minors—Karen

Patient Privacy Notice- Karen

Authorization to Release Protected Health Information—Karen

Authorization to Obtain Protected Health Information—Karen

New Patient Packet—Burmese

New Patient Packet—Burmese

Authorization for Treatment—Burmese

Authorization for the Treatment of Minors—Burmese

Patient Privacy Notice- Burmese

Authorization to Release Protected Health Information—Burmese

Authorization to Obtain Protected Health Information—Burmese

Permission to Share Patient Information

Permission to Share Patient Information—English

Permission to Share Patient Information—Spanish

Permission to Share Patient Information—Nepali

Permission to Share Patient Information—Arabic

Permission to Share Patient Information—Karen

Permission to Share Patient Information—Burmese

Controlled Substance Patient Acknowledgment

Controlled Substance Patient Acknowledgment—English

Controlled Substance Patient Acknowledgment—Spanish

Controlled Substance Patient Acknowledgment—Nepali

Controlled Substance Patient Acknowledgment—Arabic

Controlled Substance Patient Acknowledgment—Karen

Controlled Substance Patient Acknowledgment—Burmese

Health Care Proxy

Health Care Proxy—English

Health Care Proxy—Spanish 

Health Care Proxy—Chinese

Health Care Proxy—Russian 

HIV Testing

HIV Testing: Public Health Law

HIV Testing Form—English

HIV Testing Form—Spanish 

HIV Testing Form—Russian