St. Christopher's is closely monitoring the COVID-19 situation in our community. As an alternative to in-person visits, we offer convenient virtual visit options for patients and their families, where clinically appropriate.
Resources for your Virtual Visit
Below is a short collection of general forms used in the delivery of telehealth services.
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Consent for Treatment - English [PDF]
We ask that you read and sign the following Consent to Receive Treatment form. -
Consentimiento para Tratamiento - Español[PDF]
Le pedimos que lea y firme el siguiente formulario de Consentimiento para recibir tratamiento. -
Financial Responsibility - English [PDF]
We ask that you read and sign the following Financial Responsibility form to acknowledge understanding of your patient financial responsibility. -
Responsabilidad financiera - Español[PDF]
Le pedimos que lea y firme el siguiente formulario de Responsabilidad Financiera para reconocer la comprensión de su responsabilidad financiera del paciente. -
Medical Assistance - English[PDF]
Please complete the following verification form if you receive Medical Assistance. -
Asistencia Médica - Español[PDF]
Complete el siguiente formulario de verificación si recibe asistencia médica. -
Health Care Insurance Portability and Accountability Act (HIPAA)[PDF]
We ask that you read and sign the following HIPPA form to acknowledge receipt of a Notice of Privacy Practices. -
Ley de Responsabilidad y Portabilidad del Seguro de Salud (HIPAA)[PDF]
Le pedimos que lea y firme el siguiente formulario HIPPA para acusar recibo de un Aviso de prácticas de privacidad.