Patient Bill of Rights and Responsibilities
Notice of Privacy Practices – Updated June, 2021
Dental Patient Medical History Form
School-Based Dental Center History-Pre-K through 5th Grade
School-Based Dental Center History-6th through 12th Grade
Consent to Disclose Health Information
CHCB Application for Employment
Advance Directive Information and Form
Child Psychiatry Consultation Clinic Referral Form
CME Webinar Forms
Webinar 1- UTI Acute GI Illnesses Reg-Eval-PostTest – test
Webinar 2- Avoiding the ER_Peds Issues CME Paperwork
Webinar 3- Series (ER-Geriatric) CME REG-EVAL-POSTTEST
Webinar 4- Avoiding the ER: Practical Strategies and Nurse Triage Panel
Translated Materials
Patient Registration Form – Arabic
Patient Registration Form – Burmese
Patient Registration Form – Dari
Patient Registration Form – Farsi
Patient Registration Form – Nepali
Patient Registration Form – Pashto
Patient Registration Form – Somali
Patient Registration Form – Vietnamese
Dental Patient Medical History – Arabic
Dental Patient Medical History – Burmese
Dental Patient Medical History – Dari
Dental Patient Medical History – Nepali
Dental Patient Medical History – Pashto
Dental Patient Medical History – Somali
Dental Patient Medical History – Vietnamese
Sliding-Fee Scale Application – Arabic
Sliding-Fee Scale Application – Burmese
Sliding-Fee Scale Application – French
Sliding-Fee Scale Application – Nepali
Sliding-Fee Scale Application – Somali
Sliding-Fee Scale Application – Spanish
Sliding-Fee Scale Application – Vietnamese
School-Based Dental History Pre-K through 5th Grade – Arabic
School-Based Dental History 6th through 12th Grade – Arabic
School-Based Dental History Pre-K through 5th Grade – Nepali
School-Based Dental History 6th through 12th Grade – Nepali
School-Based Dental History Pre-K through 5th Grade – Somali
School-Based Dental History 6th through 12th Grade – Somali
Patient Rights and Responsibilities brochure – Arabic
Patient Rights and Responsibilities brochure – Burmese
Patient Rights and Responsibilities brochure – Nepali
Patient Rights and Responsibilities brochure – Somali
Patient Rights and Responsibilities brochure – Vietnamese
Notice of Privacy Practices brochure – Arabic
Notice of Privacy Practices brochure – Dari
Notice of Privacy Practices brochure – Farsi
Notice of Privacy Practices brochure – French
Notice of Privacy Practices brochure – Nepali
Notice of Privacy Practices brochure – Pashto
Notice of Privacy Practices brochure – Somali
Notice of Privacy Practices brochure – Swahili
Dr. Dynasaur Health Coverage info-Arabic
Dr. Dynasaur Health Coverage info-Burmese
Dr. Dynasaur Health Coverage info-Mandarin
Dr. Dynasaur Health Coverage info-Nepali