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Consent Form – Docusign
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Consent Form for No Surprises Act / Good Faith Estimate
Grievance Procedure
BH/SUD Introduction, Patient Rights and Responsibilities
Behavioral Health Intake Assessment Screener – Adult
Docusign
PDF
Behavioral Health Intake Assessment Screener – Child & Adolescent
Docusign
PDF
Release of Information Request Form – Docusign
Avisos y Formularios (en Espanol)
Formulario de inscripción – Docusign
Formulario de consentimiento – Docusign
Notificación de Prácticas de Privacidad
Consent Form for No Surprises Act / Good Faith Estimate (Spanish)
Procedimiento De Queja
BH/SUD Introduction, Patient Rights and Responsibilities (Spanish)
Behavioral Health Intake Assessment Screener – Adult (Spanish)
Docusign
PDF
Behavioral Health Intake Assessment Screener – Child & Adolescent (Spanish)
Docusign
PDF
Formulario de solicitud de divulgación de información – Docusign
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All Clinics Posts
Darlington Area Community Health Center
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CHS Website Admin
June 13, 2022
Beloit Area Community Health Center
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Danica Keeton
June 13, 2022
Beloit Area Community Health Center – Behavioral Health
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CHS Website Admin
July 28, 2017