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Home » Patient Resources and Downloads

Patient Resources and Downloads

  1.   Patient General Consent Form
      Formulario de consentimiento general
  2.   Patient Registration Form
      Formulario de registro de pacientes
  3.   Patient Client Handbook
      Manual para pacientes y clientes
  4.   Sliding Fee Scale Application
      Solicitud de descuento en la escala de pagos
  5.   Patient Payment Notice
      Formulario para descuento en la escala de pagos
  6.   Employment Verification Letter
      Carta de verificación de empleo
  7.   Notice of Privacy Practices
      Privacy Practices Notificación de Prácticas de Privacidad
  8.   Patient Emergency Handbook
  9.   Televisits Guide for Patients
  10.   Good Faith Estimate
      Estimación de buena fe
  11.   Behavioral Health: Client/Patient Consent
      Consentimiento de salud del comportamiento
  12.   Controlled Medication Agreement
      Acuerdo de medicamentos controlados
  13.   Acceptable Documentation for Proof of Income
      Documentación aceptable para prueba de ingresos
Revised 2024-0520 11:58am

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Contact CrescentCare

  504-821-2601
  info@crescentcare.org

        

Notice: NO/AIDS Task Force d.b.a. CrescentCare is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employer under 42 U.S.C. 233(g)-(n). CrescentCare has Federal Public Health Service (PHS) deemed status with respect to certain health or health related claims, including medical malpractice claims, for itself and its covered individuals. CrescentCare’s two clinical sites are FTCA Deemed Facilities.

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