Bring these forms with you each visit:
Important message from Medicare-English Important message from Medicare-Spanish
Assignment of Benefits-English Asignment of Benefits-Spanish
If you have not already completed one and have it in your hospital record:
Advance Directive/Living Will in English Advance Directive/Living Will in Spanish
Joint Privacy Notice-English Joint Privacy Notice-Spanish
Patient Bill of Rights Patient Bill of Rights - Spanish
Facility Directory-English Facility Directory-Spanish
Facility Directory/Discharge Information Facility Directory/Discharge Information - Spanish
Authorization for the Release of Patient Health Information Authorization for the Release of Patient Health Information - Spanish
Authorization for the Request of Patient Health Information From Outside Health Care Providers Authorization for the Request of Patient Health Information From Outside Health Care Providers - Spanish
Authorization for the Release of Psychiatric Health Information Authorization for the Release of Psychiatric Health Information - Spanish
Request for Amendment of the Medical Record Request for Amendment of the Medical Record - Spanish
Information Security and Privacy Complaint Form
Sleep Disorders Referral Form
Financial Assistance Income Questionnaire-English Financial Assistance Application-Spanish
Financial Assistance Application Letter-English Financial Assistance Application Letter-Spanish
Martin Health System is a not-for-profit, community-based health care organization