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expand Form Subtype : Admission ‎(1)
PA-8003505 Patient Consent and Authorization 7-14-16.pdf
  
expand Form Subtype : All Practices ‎(11)
6000096 Minor Procedure in Practice-Clinical Setting Consent.pdf
  
9004228 Diagnostic Use Authorizaiton.pdf
  
9004269 - S Controlled Substance and Pain Safety Agreement (Spanish-VFH-10.23.17).pdf
  
9004405 Authorization to Share Medical Information.pdf
  
9004858 General Consent to Treat and Registration Release Form.pdf
  
expand Form Subtype : Bariatric & Metabolic ‎(3)
6000001 Consent for the Use of Anti-Obesity Control Medications.pdf
  
9004783 Informed Consent Bariatric Exercise Program.pdf
  
expand Form Subtype : Blood Bank ‎(3)
9003860 Blood Conservation Consent.pdf
  
expand Form Subtype : Cardiovascular ‎(25)
9003933 Left and-or Right Heart Catheterization, Coronary Angiography, and-or Possible Stent Placement Consent.pdf
  
9004306 Implantable Cardioverter Defibrillator (ICD) Generator Change (ICD Battery Depletion) Consent.pdf
  
9004309 Non-Invasive Program Stimulation (NIPS) Consent.pdf
  
9004311 Device Lead Revision Consent.pdf
  
9004314 Implantable Loop Recorder Consent.pdf
  
9004317 Electrical Cardioversion Consent.pdf
  
9004322 Trans-esophageal Echocardiogram (TEE) with Electrical Cardioversion Consent.pdf
  
9004363 Insertion of Temporary Pacemaker Consent.pdf
  
9004496 Transapical Transcatheter Aortic Valve Replacement (TAVR) Procedure Consent.pdf
  
9004530 Transaortic Transcatheter Aortic Valve Replacement (TAVR) Procedure Consent.pdf
  
9004791 Placement of Left Atrial Appendage Occluder Device with Trans-esophageal Echocardiogram (TEE) Consent.pdf
  
9004958 Carotid Endarterectomy-TransCarotid Artery Revascularization-Carotid Artery Surgery Consent.pdf
  
9004990 Open Heart Surgery with Heart-Lung Machine and Transesophageal Echocardiography Consent.pdf
  
expand Form Subtype : Colon/Rectal ‎(6)
9004582 Informed Consent Procedure Incision and Drainage of Anal Rectal Abscess.pdf
  
9004586 Informed Consent Procedure Hemorroid Banding.pdf
  
9004781 Informed Consent Anorectal Manometry.pdf
  
expand Form Subtype : Consents ‎(15)
9000331 Photograph or Video Record for Medical, Educational or Personal Use Form.pdf
  
9000354 Advanced Directive for Healthcare Form.pdf
  
9003726 Telemedicine Consultation Form.pdf
  
9004365 Hyperbaric Oxygen Therapy (HBOT) Form.pdf
  
9004696 Bronson Agreement for Camera Monitoring Form.pdf
  
9004773 Testopel® Pellet Insertion for Women Form.pdf
  
M-8005500 OPIOID START TALKING. 5.23.2018. docx.pdf
  
expand Form Subtype : Critical Care ‎(3)
9004064 Percutaneous Central Venous Catheter Placement Consent.pdf
  
9004878 Percutaneous Tracheostomy Form.pdf
  
expand Form Subtype : Death ‎(2)
9003689 Release of Human Remains.pdf
  
expand Form Subtype : Dermatology ‎(11)
9004757 Informed Consent Latisse Treatment.pdf
  
9004759 Informed Consent Chemical Peel Treatment.pdf
  
9004761 Informed Consent Fractional Non-Ablative Laser Treatment.pdf
  
9004763 Informed Consent Neurotoxin injection.pdf
  
9004771 Informed Consent Photodynamic Therapy with Levulan® and Blu-U®.pdf
  
expand Form Subtype : Diabetes ‎(1)
DE-8001501 Continuous Glucose Monitoring Agreement 8-19-15.pdf
  
expand Form Subtype : ED ‎(1)
expand Form Subtype : EMTALA ‎(3)
9003602 Authorization for Transfer of Patient-EMTALA Form.pdf
  
9005056 EMTALA Essentials for the Emergency Department Form.pdf
  
expand Form Subtype : Gastroenterology ‎(26)
9003980 Laparoscopic Adjustable Gastric Band With Possible Open  Approach Informed Consent.pdf
  
9003985 Parental Refusal for Newborn Screening Consent.pdf
  
9004528 Endoscopic Retrograde Cholangiopancreatography Consent.pdf
  
9004577 Refusal of Newborn Hearing Screening.pdf
  
9004580 Informed Consent Procedure Capsule Endoscopy.pdf
  
9004646 Endoscopic Bronchial Ultrasound with Possible Fine Needle Aspiration Consent.pdf
  
9004649 24 hour PH-Impedance Probe Study with Impedance Probe Insertion.pdf
  
9004651 Colonoscopy with possible polypectomy and biopsies.pdf
  
9004653 Flexible Sigmoidoscopy with Biopsies.pdf
  
9004660 Endoscopic Ultrasound of the Esophagus, Stomach and Duodenum with possible Fine Needle Aspiration Consent.pdf
  
9004719 Esophagogastroduodenoscopy and Colonoscopy Consent.pdf
  
9004725 Informed Consent Transjugular Intrahepatic Portosystemic Shunt (TIPS).pdf
  
9004985 Electromagnetic Navigation Bronchoscopy Consent.pdf
  
expand Form Subtype : General ‎(12)
9002641 Patient Leave of Absence.pdf
  
9002795 Bronson Notice of Privacy Practice (NOPP) Form.pdf
  
9004187 Request to an External Organization for Protected Health Information.pdf
  
9004622 Request for Amendment of Protected Health Information.pdf
  
9004624 Acceptance of Request for Amendment of Protected Health Information.pdf
  
9004751 Acknowledgement of Saline Lock Education Form.pdf
  
expand Form Subtype : General Surgery ‎(2)
9004879 Soft Tissue Mass or Skin Lesion Removal Form.pdf
  
expand Form Subtype : Glycemic Control ‎(1)
expand Form Subtype : Med Oncology ‎(3)
9004965 WMCC-BHG Consent for Treatment Form.pdf
  
MO-8002708 Chemotherapy and-or Biotherapy.pdf
  
expand Form Subtype : Neuroscience ‎(19)
9003927 Placement of Wingspan Stent using the Gateway PTA Balloon Catheter.pdf
  
9003997 Thoracic, Lumbar, and-or Sacral Fusion Surgery Consent.pdf
  
9004001 Spinal Cord Stimulator Consent.pdf
  
9004022 Craniotomy for Tumor Consent.pdf
  
9004027 Ventriculoperitoneal Shunt Placement Consent.pdf
  
9004038 Thoracic and-or Lumbar Decompression Consent.pdf
  
9004074 Suboccipital Craniotomy with or without Cervical Laminectomy for Chiari Malformation Consent.pdf
  
9004101 Endovascular Cerebral Vessel Embolization Consent.pdf
  
9004800 External Ventricular Drain-Intracranial Pressure Monitor Placement Consent.pdf
  
expand Form Subtype : Neurovascular ‎(1)
9004325 Cerebral Angiography with Possible Percutaneous Transluminal Angioplasty and-or Stent Placement Consent.pdf
  
expand Form Subtype : OB (AP/L&D/MBU) ‎(10)
9001472 OB Delivery Room Attendance Agreement Consent.pdf
  
9004355 Doula Agreement.pdf
  
9004575 Refusal of Vitamin K in Newborn Consent.pdf
  
9005152 Parent to Feed Banked Breast Milk Agreement.pdf
  
RM-8003902 Delivery Room Request Consent 7-12-16.pdf
  
expand Form Subtype : OB/GYN ‎(19)
9003741 Informed Consent For Water Birth.pdf
  
9004111 Hysteroscopy with-without Dilation and Curettage (D&C) Consent.pdf
  
9004113 Laparoscopic Assisted Vaginal Hysterectomy Consent.pdf
  
9004128  Vaginal Hysterectomy Consent.pdf
  
9004237 Anterior and or Posterior Colporrhaphy Consent.pdf
  
9004300 Ovarian Cystectomy Consent.pdf
  
9004302 Oophorectomy Consent.pdf
  
9004337 Obstetric History and Genetic Screening.pdf
  
9004597 Informed Consent Procedure Colposcopy.pdf
  
expand Form Subtype : Orthopedic ‎(17)
9004216 Hip Arthroplasty Surgery Consent.pdf
  
9004327 Shoulder Replacement Surgery Consent.pdf
  
9004329 Knee Ligament Surgery Consent.pdf
  
9004392 Carpal Tunnel Surgery Consent.pdf
  
9004394 Surgical Treatment for Fractures-Dislocations Consent.pdf
  
9004396 Closed Reduction of Fracture without Internal Fixation Consent.pdf
  
9004408 Removal of Hardware or Implant Consent.pdf
  
9004437 Closed Treatment of Fracture Dislocation Consent.pdf
  
9005010 Ganglion Cyst-Mass Excision Consent.pdf
  
expand Form Subtype : Ped/Neo Intensive Care ‎(5)
9004454 Consent for Photographs of NICU Patients.pdf
  
9004676 Retinopathy of Prematurity Consent.pdf
  
expand Form Subtype : Pediatric ‎(6)
9003069 Pediatric Security System Release Form.pdf
  
9004076 Ventriculoperitoneal Pleural Atrial Shunt Consent PEDS.pdf
  
9004605 Consent for Medical Care After Possible Abuse or Neglect.pdf
  
expand Form Subtype : Plastics ‎(17)
6000027 Informed Consent Brow Lift Surgery.pdf
  
6000029 Informed Consent Skin Graft Surgery.pdf
  
9004726 Informed Consent Mastopexy (Breast Lift).pdf
  
9004741 Informed Consent Abdominoplasty.pdf
  
9004743 Blepharoplasty Consent.pdf
  
9004745  Informed Consent Suction Assisted Lipectomy.pdf
  
9004880 Panniculectomy Form.pdf
  
9004968 Mohs Reconstruction Form.pdf
  
9004970 Nasal Fracture Surgery Form.pdf
  
expand Form Subtype : Rad Oncology ‎(19)
RO-8004101 Accelerated Partial Breast Irradiation Consent 11-6-17.pdf
  
RO-8004103 Radiation Therapy of Breast-Chest Consent 11-6-17.pdf
  
RO-8004105 Radiation Therapy of Gynecomastia Consent 11-6-17.pdf
  
RO-8004107 Radiation Therapy Hodgkin's Lymphoma Consent 11-6-17.pdf
  
RO-8004109 Radiation Therapy  Metastatic Consent 11-6-17.pdf
  
RO-8004111 Prophylactic Cranial Irradiation Consent 11-6-17.pdf
  
RO-8004113 Radioactive Ra 223 Xofigo Consent 11-6-17.pdf
  
RO-8004115 Stereotactic Radiation Therapy Consent 10-26-17.pdf
  
RO-8004117 High Dose Rate Gynecological Brachytherapy Consent 10-26-17.pdf
  
expand Form Subtype : Radiology ‎(58)
6000097 Skin Biopsy for Diagnosis of Small Fiber Sensory Neuropathy (SFSN) Consent.pdf
  
9003783 Duodenoscopy Consent.pdf
  
9003998 Lumbar Puncture Consent.pdf
  
9004068 Peripherally Inserted Central Catheter PICC Consent.pdf
  
9004075 Trigger Point Injection Consent.pdf
  
9004258 Incision and Drainage Consent Peds.pdf
  
9004260 Pediatric Colonoscopy w Biopsies, Polypectomy Consent Peds.pdf
  
9004440 Discogram Consent.pdf
  
9004442 Bone Marrow Biopsy Consent.pdf
  
9004444 Kidney Mass Biopsy Consent.pdf
  
9004446 Random Kidney Biopsy Consent.pdf
  
9004449 Biopsy Liver Random Consent.pdf
  
9004468 Arthrogram Consent (Adult).pdf
  
9004471 IR Procedure without Sedation Form.pdf
  
9004479 Disc Aspiration and Biopsy Consent.pdf
  
9004481 Removal of Tunneled Pleural Drainage Catheter Consent.pdf
  
9004483 Chest Port Removal Consent.pdf
  
9004486 Drainage Chest Tube Placement Consent.pdf
  
9004587 Transarterial chemoembolization (TACE).pdf
  
9004634 Radiology Guided Tube Check with Possible Change or Removal Consent.pdf
  
9004647 Radiology guided nasogastric (NG) or nasojejunal (NJ) tube placement.pdf
  
9004664 Radiology Guided Paracentesis Consent.pdf
  
9004688 Informed Consent Myelogram.pdf
  
9004700 Drainage Aspiration Consent.pdf
  
9004790 Lung Biopsy with Possible Drainage Chest Tube Consent.pdf
  
9004798 Percutaneous Gastrostomy Tube Placement Consent.pdf
  
9004802  Informed Consent CAT scans of Pregnant Patients.pdf
  
9004813 Angiogram with Possible Vascular Embolization Consent.pdf
  
9004832 Image-Guided Ablation (Tumors) Consent.pdf
  
expand Form Subtype : Registration ‎(2)
5000002 Scheduling and Pre Surgical Testing Order Form.pdf
  
expand Form Subtype : Rehab ‎(1)
9004207 Feeding History Rehab Peds.pdf
  
expand Form Subtype : Respiratory ‎(3)
9004852 Informed Consent Mehtacholine Challenge Test.pdf
  
expand Form Subtype : Sleep Center ‎(1)
6000006 Bronson Sleep Health Advanced Notice to Bill.pdf
  
expand Form Subtype : Surgery ‎(1)
expand Form Subtype : Urology ‎(44)
6000005 Informed Consent Botox Injection for Urinary Incontinence.pdf
  
9004372 Transrectal Ultrasound Guided Prostate Biopsy Consent.pdf
  
9004374 Hydrocelectomy Consent.pdf
  
9004375 Radical Nephrectomy, Partial Nephrectomy, Nephrouecterectomy, or Adrenalectomy Consent.pdf
  
9004377 Extracorporeal Shock Wave Lithotripsy (ESWL®) Consent.pdf
  
9004455 Informed Consent Suprapubic Cystostomy.pdf
  
9004457 Informed Consent Spermatocelectomy and Excision of an Epidiymal Cyst.pdf
  
9004459 Informed Consent Pediatric Circumcision and Revision of Circumcision.pdf
  
9004461 Informed Consent Hypopadius Repair.pdf
  
9004463 Informed Consent Varicocelectomy.pdf
  
9004465 Informed Consent Prostrate Brachytherapy.pdf
  
9004472 Informed Consent Excision of Urethral Diverticulum.pdf
  
9004473 Informed Consent Ureteroscopy and Stent Placement (Stone removal, possible laser of stone).pdf
  
9004475 Informed Consent Ureteral Reimplantation.pdf
  
9004477 Informed Consent Radical and Simple Orchiectomy.pdf
  
9004493 Informed Consent Radical Cystectomy.pdf
  
9004535 Bladder Instillation.pdf
  
9004602 Plastibell Circumcision.pdf
  
9004641 Percutaneous Tibial Nerve Stimulation (PTNS) Informed Consent.pdf
  
9004834 Informed Consent Transprostatic Implant.pdf
  
9004849 Informed Consent Penile Implant.pdf
  
9004868 Cryoablation of Renal Mass.pdf
  
expand Form Subtype : Vast ‎(1)
9004862 Informed Consent Venous Cutdown.pdf
  


 



expand Form Subtype : Arabic ‎(11)
9004667-A Pediatric Procedural Sedation for Tests or Procedures Form.pdf
  
9004669-A Birth After Cesarean Section Consent (Arabic-VFH-12.21.15).pdf
  
9004692-A Registration Release Form.pdf
  
9004734 General Authorization for Use or Disclosure of Health Information (Arabic)10.23.pdf
  
9004752-A Informed Consent Insertion of IUD Consent (Arabic-VFH-5.15.17).pdf
  
9004871-A General Consent to Treat and Registration Release Form.pdf
  
expand Form Subtype : Burmese ‎(11)
9004673-B  Cesarean Section Consent (Burmese-VFH-12.17.15).pdf
  
9004675 Tubal Sterilization Consent (Burmese-VFH-3.7.19).pdf
  
9004695-B Bronson Healthcare Group Notice of Privacy Practices (NOPP)  (Burmese-VFH-12.29.17).pdf
  
9004737 Request to an External Organization for Protected Health Information (Burmese).pdf
  
9004808-B Advance Directive for Healthcare (Bilingual-English-Burmese-VFH-3.23.18).pdf
  
expand Form Subtype : Spanish ‎(62)
6000004 Practices Registration Release Form (Spanish-VFH-11.28.16).pdf
  
9000750-S Bronson Rehab Services Attend Policy Spanish.pdf
  
9002781 Authorization for Patient Transporation (spanish).pdf
  
9003078-S Registration Release Form.pdf
  
9003712 Important Message from Medicare Form (Spanish).pdf
  
9003801 OBD Fetal Kick Count Instructions Downtime Form Spanish.pdf
  
9003803 OBD Early Labor Instructions Downtime Form Spanish.pdf
  
9004188 Request to an External Organization for Protected Health Information (Spanish).pdf
  
9004269-S Controlled Substance Pain Safety Agreement (Spanish-VFH-6.18.18).pdf
  
9004504-S Request for Accounting (Spanish-VFH-11 12 13).pdf
  
9004506-S Uses and Disclosures of Protected Health Information for Certain Purposes (Spanish-VFH-11 12 13).pdf
  
9004508-S Request to Revoke (Spanish-VFH-11 12 13).pdf
  
9004521-S Advance Beneficiary Notice of Noncoverage (Spanish-VFH-12 02 13).pdf
  
9004627-S Blood Conservation Consent (Spanish-VFH-7 14 15).pdf
  
9004629 Parental Authorization for a Minor (Spanish-VFH-7.25.16).pdf
  
9004635 Tubal Sterilization Consent (Spanish-VFH-3.7.19).pdf
  
9004637-S Birth After Cesarean Section Consent (Spanish-VFH-8 11 15).pdf
  
9004642-S Trans-esophageal Echocardiogram (TEE) with Electrical Cardioversion Consent (Spanish-VFH-9 15 15).pdf
  
9004658-S Patient Services Family Needs Survey Spanish.pdf
  
9004704-S developmental checklist birth - 2 months (spanish-vfh-10.30.13).pdf
  
9004706-S developmental checklist - 6-8 months (spanish-vfh-10.30.13).pdf
  
9004708-S developmental checklist - 12-15 months-en-es-c (rev ac 10 14 13).pdf
  
9004710-S Developmental Checklist - 20-24 months-en-es-C (rev AC 10 14 13).pdf
  
9004712-S developmental checklist - 2 5 - 3 years-en-es-c (rev ac 10 14 13).pdf
  
9004714-S developmental checklist - 4 years-(spanish-vfh-10.30.13).pdf
  
9004732-S Diagnostic Use Authorization Spanish.pdf
  
9004754-S Informed Consent Insertion of IUD Consent (Spanish-VFH-5.25.17).pdf
  
9004776 Total Hip Arthroplasty Surgery Consent (Spanish-VFH-10.4.17).pdf
  
9004778 Detailed Notice of Discharge Form (Spanish).pdf
  
9004809-S Advance Directive for Healthcare (Bilingual ENG-SPA-VFH-6.28.18).pdf
  
9004870-S General Consent to Treat and Registration Release Form.pdf
  
(More Documents...)