Medical Forms and Patient Rights

Patient Profile Form

Patient Profile
New patients are encouraged to print and fill out this form for their first appointment. If you are an existing patient, you can use this form to change or update your information, including your address.

Protected Health Information (PHI)

Authorization to Use and Disclose Protected Health Information

Primary Care Physician (PCP) Change Forms

BMC Health Net Plan
CeltiCare
Network Health
Neighborhood Health Plan
Tufts Health Plan
UnitedHealthcare

Healthcare Proxy Forms

Massachusetts Healthcare Proxy Form and Instructions
Poder Para Tomar Decisiones Medicas En Massachusetts (Spanish Healthcare Proxy Form)

Patient Rights

Patient Bill of Rights
Patient Notice of Non-Discrimination
Patient Privacy Notice

Policies

 South End Community Health Center: Health Safety Net Credit & Collection Policy