Patient Forms
Access patient forms and resources needed for getting started with Vibe.
Patient Forms
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Authorization for Release of Medical Information (English)
This allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
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Authorization for Release of Medical Information (Spanish)
This allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
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Authorization and Consent for Treatment (English)
All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.
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Authorization and Consent for Treatment (Spanish)
All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.
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Informed Consent for Telehealth Services (English)
This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.
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Informed Consent for Telehealth Services (Spanish)
This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.
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Patient Designated Contacts (English)
Patients are encouraged to complete and return the Patient Designated Contacts Form to Vibe, but it is not required.
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Patient Designated Contacts (Spanish)
Patients are encouraged to complete and return the Patient Designated Contacts Form to Vibe, but it is not required.
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Health Information Exchange (HIE) Opt-Out (English)
This form allows patients to opt out of sharing their PHI via the Health Information Exchange (HIE). The HIE securely shares patient information electronically.
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Health Information Exchange (HIE) Opt-Out (Spanish)
This form allows patients to opt out of sharing their PHI via the Health Information Exchange (HIE). The HIE securely shares patient information electronically.
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Practice Financial Policies (English)
This form advises patients of their financial responsibility for all services received without regard to insurance eligibility or coverage determinations.
Practice Information
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