Below are common forms you may need. For more information, contact your care provider directly.
Forms you may need
Advance Medical Directive (Virginia)
SA国际传媒care and the SA国际传媒Center for Healthcare Ethics are offering the community the opportunity to complete their Advance Care Plan (Advance Directive) and register it, free of charge, with our national Advance Directive Registry through the U.S. Living Will Registry. Where ever you go in the United States your Advance Care Plan will be accessible by healthcare professionals when needed to guide your medical care if you are unable to communicate your wishes or make your own decisions.
Advance Medical Directive (North Carolina)
SA国际传媒care and the SA国际传媒Center for Healthcare Ethics are offering the community the opportunity to complete their Advance Care Plan (Advance Directive) and register it, free of charge, with our national Advance Directive Registry through the U.S. Living Will Registry. Where ever you go in the United States your Advance Care Plan will be accessible by healthcare professionals when needed to guide your medical care if you are unable to communicate your wishes or make your own decisions.
Authorization for Release of Medical Information
You will need this to submit this form to request paper medical records.
Maternity Pre-Admission Form
At the beginning of your third trimester, we encourage you to pre-admit your hospital stay. This ensures your information is in our system before your special day arrives.
SA国际传媒Medical Group New Patient Form
If you are a new patient for a SA国际传媒Medical Group practice, download this form. Print and complete the form, and bring it with you to your first visit.
SA国际传媒Medical Group Authorization to Disclose Protected Health Information
If you want to have a medical record transferred from another doctor’s office to your new SA国际传媒Medical Group office, please complete this form. Likewise, this form can also be used to authorize someone other than you to have access to information about your healthcare status on treatment. Just print and complete the form and bring it with you to your next appointment.
Consent for Treatment & Financial Agreement
To review a copy of the SA国际传媒Hospitals and SA国际传媒Medical Group Consent for Treatment & Financial Agreement details. (Note: Must be completed and signed in-person. Do not print).
Consent for Treatment & Financial Agreement - Español
To review a copy of the SA国际传媒Hospitals and SA国际传媒Medical Group Consent for Treatment & Financial Agreement details. (Note: Must be completed and signed in-person. Do not print).
Consent for Treatment & Financial Agreement (Charlottesville)
To review a copy of the SA国际传媒Hospitals and SA国际传媒Martha Jefferson Medical Group Consent for Treatment & Financial Agreement details. (Note: Must be completed and signed in-person. Do not print).