What We Do

Patient Forms

  • The purpose of this form is to provide screening and documentation of the eligibility status.

  • The purpose of this form is to provide documentation of patient medical history.

  • Protected health information (PHI) under US law is any information about health status, provision of health care, or payment for health care that is created or collected by a "Covered Entity" (or a Business Associate of a Covered Entity), and can be linked to a specific individual.