Patient Documents

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Patient Documents

Elderly woman looking at resources on her phone and taking notes in notebook

Our Mission Extends Beyond Filling Prescriptions

AcariaHealth provides comprehensive services including educational resources to help you understand your diagnosis, treatment, and available support.

Welcome Letter

document example: Welcome letter

English - Download (PDF)

document example: Welcome letter Spanish

Spanish - Download (PDF)

Patient's Bill of Rights and Responsibilities

document example: Patient bill of rights

English - Download (PDF)

document example: Patient's Bill of Rights and Responsibilities Spanish

Spanish - Download (PDF)

Notice of Privacy Practices Acknowledgement of Receipt

document example: Privacy Practices

English - Download (PDF)

document example: Notice of Privacy Practices Acknowledgement of Receipt Spanish

Spanish - Download (PDF)

Language Assistance/Nondiscrimination Notice

document example: language assistance

English - Download (PDF)

document example: Language Assistance Spanish

Spanish - Download (PDF)

Frequently Asked Questions

document example: FAQ

English - Download (PDF)

document example: Frequently Asked Questions Spanish

Spanish - Download (PDF)

Medicare Prescription Coverage and Your Rights

document example: Prescription coverage

English - Download (PDF)

document example: Medicare Prescription Coverage and Your Rights Spanish

Spanish - Download (PDF)

Notice of Privacy Practices Booklet

document example: Notice of Privacy Practices

English - Download (PDF)

document example: Notice of Privacy Practices Spanish

Spanish - Download (PDF)

Additional Patient Documents

Patient HIPAA Authorization Form (PDF)

Assignment Agreement (PDF)

Safe SHARPS Disposal (PDF)

Emergency Management Plan (PDF)

Proper Medication Disposal (PDF)

Best Practices for Administering Medications and Handling Supplies (PDF)

Complaint Form (PDF)

Fast, Accessible, Secure Prescription Management

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