Patient Forms

HIPAA Consent

HIPAA protects the confidentiality and security of a patient's health care information; therefore, it is required that we get your written consent for certain information.

Notice of Privacy Practices

This is our notice of privacy practices, which describes how medical information about you may be used and disclosed and how you can get access to this information.

HEALTHeLINK Consent Form

This consent form gives us authorization to access health information regarding my care and treatment through HEALTHeLINK.

Financial Policy

Patient Bill of Rights

As a patient in a hospital in New York State, you have the right, consistent with law, to a bill of rights.

Surescripts Consent Form

Surescripts is an electronic database used to access your medication history. With your consent we will download list of your past and present medications to your personal chart. Knowing and understanding your medications is what makes us able to give you the best treatment, the treatment you deserve.