{"id":716,"date":"2016-08-31T06:27:31","date_gmt":"2016-08-31T06:27:31","guid":{"rendered":"http:\/\/peds1.merosaman.com\/?page_id=716"},"modified":"2024-01-15T00:54:11","modified_gmt":"2024-01-15T00:54:11","slug":"forms","status":"publish","type":"page","link":"https:\/\/dev3.pcpedsfm.com\/?page_id=716","title":{"rendered":"Forms"},"content":{"rendered":"<section id=\"bt_section6adc4f07dd842\"  class=\"boldSection topSpaced bottomSpaced gutter inherit\" ><div class=\"port\"><div class=\"boldCell\"><div class=\"boldCellInner\"><div class=\"boldRow  \" ><div class=\"boldRowInner\"><div class=\"rowItem col-md-12 col-ms-12  btTextLeft animate animate-fadein animate-moveleft inherit btDoublePadding\"  ><div class=\"rowItemContent\" ><div class=\"btClear btSeparator topSpaced bottomSmallSpaced noBorder\" ><hr><\/div><header class=\"header btClear large btDash topDash  btAccentDash\" ><div class=\"dash\"><h2><span class=\"headline\">FORMS<\/span><\/h2><\/div><\/header><div class=\"btClear btSeparator bottomSemiSpaced noBorder\" ><hr><\/div><header class=\"header btClear medium  btNormalDash\" ><div class=\"dash\"><h3><span class=\"headline\">Pediatric Forms:<\/span><\/h3><\/div><\/header><div class=\"btText\" ><\/p>\n<div class=\"detail-text\">\n<ul>\n<li><a href=\"https:\/\/www.pcpedsfm.com\/wp-content\/uploads\/2024\/01\/RECORDS-RELEASE-TO-PCPFM-2022-REV-11.2024.pdf\">Authorization to Release or Obtain Medical Information<\/a> (PDF)<\/li>\n<li><a href=\"https:\/\/www.pcpedsfm.com\/wp-content\/uploads\/2024\/01\/PCPFM-Pediatrics-Patient-Demographics-Form-2024.pdf\">Patient Demographics<\/a> (PDF)<\/li>\n<li><a href=\"https:\/\/www.pcpedsfm.com\/wp-content\/uploads\/2024\/01\/PCPFM-Consent-to-Treat-2024.pdf\">Consent to Treat<\/a> (PDF)<\/li>\n<li><a href=\"https:\/\/www.pcpedsfm.com\/wp-content\/uploads\/2024\/01\/Pediatric-Patient-history-2024.pdf\">Patient History<\/a> (PDF)<\/li>\n<li><a href=\"https:\/\/www.pcpedsfm.com\/wp-content\/uploads\/2024\/01\/OFFICE-POLICY-2024.pdf\">PCPFM Office Policy<\/a> (PDF)<\/li>\n<li><a href=\"https:\/\/www.pcpedsfm.com\/wp-content\/uploads\/2024\/01\/Financial-Policy-2024-2.pdf\">PCPFM Financial Policy<\/a> (PDF)<\/li>\n<li><a href=\"https:\/\/www.pcpedsfm.com\/wp-content\/uploads\/2024\/01\/HIPAA-Policy-2024-2.pdf\">PCPFM HIPPA Policy<\/a> (PDF)<\/li>\n<li><a href=\"https:\/\/www.pcpedsfm.com\/wp-content\/uploads\/2024\/01\/Receipt-of-Notice-of-Privacy-Practices-Written-Acknowledgement-Form-2024.pdf\">Receipt of Notice of Privacy Practices Written Acknowledgement Form<\/a> (PDF)<\/li>\n<\/ul>\n<\/div>\n<p>\n<\/div><div class=\"btClear btSeparator bottomSemiSpaced noBorder\" ><hr><\/div><header class=\"header btClear medium  btNormalDash\" ><div class=\"dash\"><h3><span class=\"headline\">Adult Forms:<\/span><\/h3><\/div><\/header><div class=\"btText\" ><\/p>\n<div class=\"detail-text\">\n<p>For patient more than 21 years of age.<\/p>\n<ul>\n<li><a href=\"https:\/\/www.pcpedsfm.com\/wp-content\/uploads\/2024\/01\/RECORDS-RELEASE-TO-PCPFM-2022-REV-11.2024.pdf\">Authorization to Release or Obtain Medical Information<\/a> (PDF)<\/li>\n<li><a href=\"https:\/\/www.pcpedsfm.com\/wp-content\/uploads\/2024\/01\/OFFICE-POLICY-2024.pdf\">PCPFM Office Policy<\/a> (PDF)<\/li>\n<li><a href=\"https:\/\/www.pcpedsfm.com\/wp-content\/uploads\/2024\/01\/Financial-Policy-2024-2.pdf\">PCPFM Financial Policy<\/a> (PDF)<\/li>\n<li><a href=\"https:\/\/www.pcpedsfm.com\/wp-content\/uploads\/2024\/01\/HIPAA-Policy-2024-2.pdf\">PCPFM HIPPA Policy<\/a> (PDF)<\/li>\n<li><a href=\"https:\/\/www.pcpedsfm.com\/wp-content\/uploads\/2018\/02\/FAMILY-MEDICINE-PATIENT-HISTORY.pdf\" target=\"_blank\">Patient History<\/a> (PDF)<\/li>\n<li><a href=\"\/wp-content\/uploads\/2019\/01\/PCPFM-Adult-Patient-Demographics-Form-2019-.pdf\">Patient Demographics<\/a> (PDF)<\/li>\n<li><a href=\"\/wp-content\/uploads\/2019\/01\/Receipt-of-Notice-of-Privacy-Practices-Written-Acknowledgement-Form-2019.pdf\">Receipt of Notice of Privacy Practices Written Acknowledgement Form<\/a> (PDF)<\/li>\n<\/ul>\n<\/div>\n<p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-716","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/dev3.pcpedsfm.com\/index.php?rest_route=\/wp\/v2\/pages\/716","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dev3.pcpedsfm.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dev3.pcpedsfm.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dev3.pcpedsfm.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dev3.pcpedsfm.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=716"}],"version-history":[{"count":25,"href":"https:\/\/dev3.pcpedsfm.com\/index.php?rest_route=\/wp\/v2\/pages\/716\/revisions"}],"predecessor-version":[{"id":1265,"href":"https:\/\/dev3.pcpedsfm.com\/index.php?rest_route=\/wp\/v2\/pages\/716\/revisions\/1265"}],"wp:attachment":[{"href":"https:\/\/dev3.pcpedsfm.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=716"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}