Medical Forms
Medical Expense Form & Privacy Policy
According to the Health Insurance Portability and Accountability Act (HIPAA), we are required to maintain the privacy of Protected Health Information (PHI) for all our patients and to provide individuals with notice of our legal duties and privacy practices with respect to PHI. PHI is any information about health status, provision of health care, or payment for health care that can be linked to an individual.
Notice of Privacy Policy
This form details our Privacy Policy, and describes how your medical information may be used and disclosed.
Medical Expense Report Request Form
To request your medical expense information, first print out and complete this form, then take it to your local pharmacy.