Forms

FORMS

 

To expedite your records requests please download and complete the forms below. Completed forms may be submitted to the Healthe Clinic front desk during your next appointment or faxed to (816) 448-0020.

If you have questions regarding the release of medical records please send a secure message using your Cerner Health Portal account to the “records request” inbox. Completed and signed records request forms may be submitted via the portal to the “records request” inbox. Please allow seven to ten business days for medical records requests to be processed.

Parental Preauthorization for Medical Care to Children

Release of Information

Hep B Declination Form

Pharmacy Mail Order Login

Notice of Privacy Practices

Motion Capture Waiver