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Patient Registration
For registration at The Baton Rouge Clinic, AMC
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Medical Records
Release of Protected Health Information:
- HIPAA PRIVACY NOTICE
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- The HIPAA Privacy Notice describes how health information about you may be used and disclosed and how you can get access to this information.
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- RELEASE FROM THE BATON ROUGE CLINIC, AMC
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- This form will allow you to release your records from The Baton Rouge Clinic, AMC to another organization or individual.
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- RELEASE TO THE BATON ROUGE CLINIC, AMC
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- This form is used to request your records from another organization to be released to The Baton Rouge Clinic, AMC.
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- RIGHT OF ACCESS
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- This form allows the authorized person of your choosing to access your records. (i.e. Giving spouse access to other spouse’s records, Son or daughter accessing parent’s records, etc.)
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For the Release of Medical Records
Phone: (225) 246-9770
Fax: (225) 246-9209 - HIPAA PRIVACY NOTICE
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National Institute for Children's Health Quality (NICHQ) Forms for Pediatric Patients
These forms are part of a child’s comprehensive assessment for ADD/ADHD.
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MyChart Proxy Forms
To read the MyChart Terms and Conditions of Use, please click here.
- MYCHART ADULT PROXY FORM
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- To request access to the MyChart record of an adult whose medical care you help manage, please complete this form.
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- MYCHART TEEN PROXY FORM
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- To request full proxy access to the MyChart record of your teenage child, 15 to 17 years old, please complete this form.
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- MYCHART CHILD PROXY FORM
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- To sign up for access to your child’s (aged 0-14 years) MyChart record, please complete both pages of this Child Proxy Form.
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The completed form can be returned to your Primary Care Provider’s Office or faxed to (225) 246-9140.
- MYCHART ADULT PROXY FORM
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Vaccine Forms
Please print and bring these forms to your vaccine appointments.
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Dermatology Forms & Information
Instructions for before and after procedures and brochure overview.
- COSMETIC SERVICES BROCHURE
- PRE PROCEDURE BBL
- POST PROCEDURE BBL
- PRE PROCEDURE LASER HAIR REDUCTION/REMOVAL
- POST PROCEDURE LASER HAIR REDUCTION/REMOVAL
- PRE PROCEDURE LASER RESURFACING
- POST PROCEDURE LASER RESURFACING
- PRE PROCEDURE MICRO LASER PEEL
- POST PROCEDURE MICRO LASER PEEL
- PRE PROCEDURE PROFRACTIONAL
- POST PROCEDURE PROFRACTIONAL
- SCLEROTHERAPY PATIENT INSTRUCTIONS
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Surgery Forms
Surgery forms recommended by our doctors.
Breast Cancer:
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Sleep Medicine Forms
Sleep Medicine forms recommended by our doctors.
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Miscellaneous Forms
General forms as recommended by our doctors.
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MRI Forms
Questions, surveys and authorization forms.
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Application for Employment
Paper application for employment