Capital Pediatrics New Patient Information
To expedite your child’s first appointment, we are happy to make our New Patient Packets and Privacy Policy available online. Please print and complete the forms below. Please bring your child’s completed New Patient Packet, as well as the requested information, to your child’s first appointment. Should you have any questions, please don’t hesitate to call the clinic where your child will be seen and someone will be happy to help you. We look forward to meeting you and your child – welcome to our practice!
Medical Records Release Form - Authorization for Release of Protected Health Information
Autorización para Revelar Información de Salud Protegida
Request for Correction and Amendment of Protected Health Information
Solicitud de Corrección y Enmienda de Información de Salud Protegida
Request for Restriction and Limitation of Protected Health Information
Solicitud de Restricción y Limitación de Información de Salud Protegida
Request For Accounting of Disclosure of Protected Health Information
Solicitud de Contabilización de Divulgación de Información de Salud Protegida
