{"id":401,"date":"2022-06-15T21:21:08","date_gmt":"2022-06-15T21:21:08","guid":{"rendered":"https:\/\/www.hicommunityhealthcenter.org\/?page_id=401"},"modified":"2022-08-02T08:40:18","modified_gmt":"2022-08-02T18:40:18","slug":"patient-forms-west","status":"publish","type":"page","link":"https:\/\/www.hicommunityhealthcenter.org\/patient-forms-west\/","title":{"rendered":"Patient Forms (West Side)"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[vc_row][vc_column][vc_column_text width=&#8221;100rem&#8221;]\n<p class=\"lead\">Hawai\u02bbi Island Community Health Center provides you with the opportunity to complete or view our patient forms before your appointment. PDF forms are provided below.<\/p>\n<p>Hawai\u02bbi Island Community Health Center is committed to protecting the privacy of our patients and complies with the Health Insurance Portability and Accountability Act (HIPAA). We encourage our patients to read their Patient Rights and Responsibilities to be well-informed and discuss their decisions with our health care team.<\/p>\n<p><span class=\"wpex-text-lg\"><strong>Medical<\/strong><\/span><\/p>\n<p><strong>English<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/www.hicommunityhealthcenter.org\/wp-content\/uploads\/Adult-New-Patient-Form-English.pdf\">Adult New Patient Packet<\/a><\/li>\n<li><a href=\"https:\/\/www.hicommunityhealthcenter.org\/wp-content\/uploads\/HI22_130_HICHC-AdultInitialHealth_Hx.pdf\">Adult Medical Health History<\/a><\/li>\n<li><a href=\"https:\/\/www.hicommunityhealthcenter.org\/wp-content\/uploads\/Keiki-New-Patient-Form-English.pdf\">Keiki (Pediatric) New Patient Packet<\/a><\/li>\n<li><a href=\"https:\/\/www.hicommunityhealthcenter.org\/wp-content\/uploads\/HI22_129_HICHC-InitialPediatricHealth_Hx.pdf\">Keiki (Pediatric) Medical Health History<\/a><\/li>\n<li>Authorization for Release of Information<\/li>\n<li>Medicare Annual Wellness Visit Questionnaire<\/li>\n<\/ul>\n<p><strong>Spanish<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/www.hicommunityhealthcenter.org\/wp-content\/uploads\/Adult-New-Patient-Form-Spanish.pdf\">Adult New Patient Packet<\/a><\/li>\n<li><a href=\"https:\/\/www.hicommunityhealthcenter.org\/wp-content\/uploads\/Keiki-New-Patient-Form-Spanish.pdf\">Keiki (Pediatric) New Patient Packet<\/a><\/li>\n<\/ul>\n<p><strong>Marshallese<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/www.hicommunityhealthcenter.org\/wp-content\/uploads\/Adult-New-Patient-Form-Marshallese.pdf\">Adult New Patient Packet<\/a><\/li>\n<li><a href=\"https:\/\/www.hicommunityhealthcenter.org\/wp-content\/uploads\/Keiki-New-Patient-Form-Marshallese.pdf\">Keiki (Pediatric) New Patient Packet<\/a><\/li>\n<\/ul>\n<p><span class=\"wpex-text-lg\"><strong>Dental<\/strong><\/span><\/p>\n<ul>\n<li><a href=\"https:\/\/www.hicommunityhealthcenter.org\/wp-content\/uploads\/HI22_132_DentalAdult_NewPatientPacket.pdf\">Adult Dental New Patient Packet<\/a><\/li>\n<li><a href=\"https:\/\/www.hicommunityhealthcenter.org\/wp-content\/uploads\/HI22_131_DentalKeiki_NewPatientPacket.pdf\">Keiki (Pediatric) Dental New Patient Packet<\/a><\/li>\n<\/ul>\n<p><strong><span class=\"wpex-text-lg\">Forms for Help with Payment<\/span><\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/www.hicommunityhealthcenter.org\/wp-content\/uploads\/22_128_HICHC_SlidingFeeApp_Complete_En.pdf\">Sliding Fee Scale Discount Application<\/a><\/li>\n<\/ul>\n<p><strong><span class=\"wpex-text-lg\">Three easy ways to submit your forms:<\/span><\/strong><\/p>\n<ol>\n<li><strong>Fax:<\/strong>\u00a0Scan completed forms and fax to <a href=\"tel:8083299451\">808-329-9451<\/a> or<a href=\"tel:8083295057\"> 808-329-5057<\/a><\/li>\n<li><strong>Email:<\/strong> Scan completed forms and email them to <a href=\"mailto:medical.records@hicommunityhealthcenter.org\">medical.records@hicommunityhealthcenter.org<\/a><\/li>\n<li><strong>In-Person<\/strong>: Bring your completed forms to our Kuakini Health Center, where you can drop them off with one of our medical screeners without even coming inside. 75-5751 Kuakini Highway, Ste. 104, Kailua-Kona, HI 96740<\/li>\n<\/ol>\n[\/vc_column_text][\/vc_column][\/vc_row]\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text width=&#8221;100rem&#8221;] Hawai\u02bbi Island Community Health Center provides you with the opportunity to complete or view our patient forms before your appointment. PDF forms are provided below. Hawai\u02bbi Island Community Health Center is committed to protecting the privacy of our patients and complies with the Health Insurance Portability and Accountability Act (HIPAA). We encourage our&hellip;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"acf":[],"_links":{"self":[{"href":"https:\/\/www.hicommunityhealthcenter.org\/wp-json\/wp\/v2\/pages\/401"}],"collection":[{"href":"https:\/\/www.hicommunityhealthcenter.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.hicommunityhealthcenter.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.hicommunityhealthcenter.org\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hicommunityhealthcenter.org\/wp-json\/wp\/v2\/comments?post=401"}],"version-history":[{"count":10,"href":"https:\/\/www.hicommunityhealthcenter.org\/wp-json\/wp\/v2\/pages\/401\/revisions"}],"predecessor-version":[{"id":1256,"href":"https:\/\/www.hicommunityhealthcenter.org\/wp-json\/wp\/v2\/pages\/401\/revisions\/1256"}],"wp:attachment":[{"href":"https:\/\/www.hicommunityhealthcenter.org\/wp-json\/wp\/v2\/media?parent=401"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}