Forms and Resources
New Patient Packet
This form is for any patient that wants to establish care with Tuolumne Me-Wuk Indian Health Center.
Patient Rights, Responsibilities & Privacy Practices
This form is Tuolumne Me-Wuk Indian Health Center’s Notice of Privacy Practices.
Request for Medical Records
This form is for any patient requesting copies of their own health information records.
PHI Authorization
This form will allow a 3rd party, whether it is another healthcare organization, a spouse, or a family member, to have access to any health record that the patient has authorized on the form.
Medicare Wellness Visit
This form is for patients receiving a Medicare Wellness Visit.
Minor Treatment Authorization
This form allows parents or legal guardians to authorize medical treatment for a minor in their absence.