Thursday, 21 February 2019

Consultants in Pain Medicine, PA

Mark A. Moran, M.D., M.S.

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Patient Forms

Please click on the form links below to download a PDF version of the form.

  • New Patient Registration Packet (100KB - PDF)
  • Narcotic Agreement (58KB - PDF)
  • Authorization for Release of Information (New Patient) (101KB - PDF)
  • Authorization for Release of Information (ROI) (65KB - PDF)
  • Notice of Privacy Practices (25KB- PDF)

  

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Call (210) 546-1470

Notice of Privacy Practices

Please be advised that Consultants in Pain Medicine is in compliance with all HIPAA guidelines. The following is a summary of our HIPAA Notice of Privacy Practices.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Notice of Privacy Practices »

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