Patient Documents

Our Mission Extends Beyond Filling Prescriptions

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

document example: Welcome letter

Welcome Letter (English) 

Download (PDF)
document example: Patient bill of rights

Patient's Bill of Rights and Responsibilities (English)

Download (PDF)
document example: language assistance

Language Assistance/Nondiscrimination Notice (English)

Download (PDF)

Additional Patient Documents

Notice of Privacy Practices Booklet (English) (PDF)
Patient HIPAA Authorization Form (PDF)
Assignment Agreement (PDF)
Emergency Management Plan (PDF)
document example: FAQ

Frequently Asked Questions (English)

Download (PDF)
document example: Privacy Practices

Notice of Privacy Practices Acknowledgment of Reciept (English)

Download (PDF)
document example: Prescription coverage

Medicare Prescription Coverage and Your Rights (English)

Download (PDF)
Emergency Management Plan (PDF)
Proper Medication Disposal (PDF)
Safe SHARPS Disposal (PDF)
Complaint Form (PDF)

Fast, Accessible, Secure Prescription Management

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