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Policy Notice and Privacy Practices
Patient Privacy Directive/Auth to bring to appointment
Change of Address Form
Child Change of Insurance Form
Adult Change of Insurance Form
Accepting new Medicaid and commercial insurance for children. Now accepting commercial insurance for adults.
Adult Medical History Form
Authorization for us to RECEIVE information
Child Medical History Form
Authorization for us to release information/Records Request Form
Private Pay Agreement for Medicaid
Coordination of Care
Bracken Psychiatric Services
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