New and current patients of 太平洋心理与综合健康诊所 can find all their required documents and forms online.

对于新患者

It is important that our new patients have reviewed our 新客户导向和知情同意 as well as our 私隐措施通知 before getting started with services at our clinic. 你需要在第一次预约前签字确认你已经看过这些文件了。

通过MyChart安全电子邮件和医疗记录

We strongly encourage all patients to sign up for MyChart to communicate with their clinicians about appointments, submit required documents, and receive medical records. We have written instructions in 英语 and 西班牙语, as well as video instructions in 英语 and 西班牙语.

If your child is 12 years or older, the parent or guardian must complete the MyChart父子代理表单 to access their child's record via MyChart. If you are an adult who would like to authorize another adult to access your record via MyChart, please complete the MyChart成人代理访问表单. 这可以邮寄或传真到我们的诊所。

If you have requested we send your medical records via MyChart, 这里有安博体育如何查看和下载它们的说明.

自付病人

对于使用收入折扣支付PCH服务的患者，我们需要每6个月更新您的收入文件。 这些文件可以通过邮件或传真接收，对于远程医疗患者，我们可以通过与诊所工作人员的电话交谈口头记录接收。 这些文件可能包括以下部分或全部内容：

• PCH自费协议自费患者每年需填写此文件。
• 请求限制不支付健康计划账单所有自费服务的病人每年都要填写这份文件，以确认我们无法为他们的健康保险计划开出账单。
• 个人入息申报表格：对于无法提供收入证明的自费患者，需每年填写一次。 向诊所工作人员提交收入证明文件（税单、工资存根等）是收入证明文件的首选方法。
• 通过MyChart创建一个支付计划.

索要你的医疗记录

To receive a copy of your medical records or request they be sent to another provider, 下载并完成此授权 and mail or fax to the clinic where you receive services.