Printable/Interactive Forms
Important Patient Information
The patient registration packet can be downloaded and filled in using your personal device: PC, Laptop ETC. you can then print it off without having to fill it all in by hand, you will just need to sign any parts requiring a signature.
Below is a list of medical record release forms. Should you have any questions about which one is appropriate, please feel free to contact our medical records department at
(910) 323-3183
ext. 108.
Forms
- Medicare Shared Savings Program Accountable Care Organizations
- Form used for payment arrangements when a patient has an outstanding balance with our organization.
- Patient Registration. Complete for New Patients and to update patient information for all practices.
- In addition to the patient packet you will need to have this for ENDO patients only.
- Mylinks portal integration
- Medical Records Release Form. Print out, complete and bring in to office.
- Notice of Privacy Practices.
Patient Authorization for Disclosure of PHI
- Patient Authorization to Disclose PHI to Family Member. Print out, complete and bring to office.
- Notice of Privacy Practices Receipt and Protected Health Information Use and Disclosure Consent. Print out, sign and bring in to office.
Health Insurance Coverage Default
- Health Insurance Coverage Default Policy. Print out, complete, sign and bring in to office.
Cape Fear Family Medical Care Endocrinology Patient Registration
- Cape Fear Family Medical Care Endocrinology Patient Registration
- Policy Acceptance Form for Cape Fear Family Medical Care. Print out, complete and bring to appointment.
Cape Fear Family Medical Care Endocrinology Policy Acceptance Form
- Policy Acceptance Form for Cape Fear Family Medical Care Endocrinology. Print out, complete and bring to appointment.