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1217 S. East Ave. Suite 104 - Sarasota FL, 34239 Phone: 941-365-0433
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Hybrid Care
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Home
Team
Hybrid Care
Services
Office Procedures
Forms
Contact Us
Forms & Information to Download
For New Establishing Patients Only
New Patient Paperwork
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For Already Established Patients
Annual Paperwork
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Notice of Privacy Practices (Trifold)
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Permission For E-Mail Communication
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Acknowledgement of Receipt of Notice of Privacy Practices Assignment of Insurance Benefits
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Authorization to Use and Disclose Health Information
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Patient Consent for Use and Disclosure of Protected Health Information
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Patient Medical/Family History
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Permission to Release Information to Non-Medical Persons (Emergency Contacts)
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Accepted Insurances
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