{"id":357,"date":"2016-02-21T22:08:04","date_gmt":"2016-02-21T22:08:04","guid":{"rendered":"http:\/\/fcpchealth.com\/?page_id=357"},"modified":"2025-01-27T08:40:37","modified_gmt":"2025-01-27T13:40:37","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/fcpchealth.com\/es\/patient-forms\/","title":{"rendered":"Formulario de Pacientes"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"357\" class=\"elementor elementor-357\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1baea6e e-flex e-con-boxed e-con e-parent\" data-id=\"1baea6e\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-306401b elementor-widget elementor-widget-image\" data-id=\"306401b\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1899\" height=\"649\" src=\"https:\/\/fcpchealth.com\/wp-content\/uploads\/2024\/11\/m1-b.jpg\" class=\"attachment-full size-full wp-image-1429\" alt=\"\" srcset=\"https:\/\/fcpchealth.com\/wp-content\/uploads\/2024\/11\/m1-b.jpg 1899w, https:\/\/fcpchealth.com\/wp-content\/uploads\/2024\/11\/m1-b-300x103.jpg 300w, https:\/\/fcpchealth.com\/wp-content\/uploads\/2024\/11\/m1-b-1024x350.jpg 1024w, https:\/\/fcpchealth.com\/wp-content\/uploads\/2024\/11\/m1-b-768x262.jpg 768w, https:\/\/fcpchealth.com\/wp-content\/uploads\/2024\/11\/m1-b-1536x525.jpg 1536w, https:\/\/fcpchealth.com\/wp-content\/uploads\/2024\/11\/m1-b-18x6.jpg 18w, https:\/\/fcpchealth.com\/wp-content\/uploads\/2024\/11\/m1-b-637x218.jpg 637w, https:\/\/fcpchealth.com\/wp-content\/uploads\/2024\/11\/m1-b-970x332.jpg 970w, https:\/\/fcpchealth.com\/wp-content\/uploads\/2024\/11\/m1-b-214x73.jpg 214w\" sizes=\"(max-width: 1899px) 100vw, 1899px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-198ea39d e-flex e-con-boxed e-con e-parent\" data-id=\"198ea39d\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-27637a4f elementor-widget elementor-widget-text-editor\" data-id=\"27637a4f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<h3>English<\/h3>\n\n<!-- Generated using Document Gallery. Get yours here: http:\/\/wordpress.org\/extend\/plugins\/document-gallery -->\n<div id=\"document-gallery-1\" class=\"document-gallery\" data-shortcode='{\"id\":357,\"include\":\"359,360,361,363,365\",\"exclude\":\"\",\"attachment_pg\":false,\"columns\":4,\"descriptions\":false,\"fancy\":true,\"limit\":-1,\"mime_types\":\"application,video,text,audio,image\",\"new_window\":false,\"order\":\"ASC\",\"orderby\":\"post__in\",\"paginate\":true,\"post_status\":\"any\",\"post_type\":\"attachment\",\"relation\":\"AND\",\"skip\":0}' data-icon-width='24'>\n<div class='document-icon-row'>\n   <div class=\"document-icon\">\n      <a href=\"https:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Adult-Medical-History-Form-ENGLISH.pdf\" target=\"_self\">\n         <img decoding=\"async\" src=\"https:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Adult-Medical-History-Form-ENGLISH-thumb.png\" title=\"Formulario de historial m\u00e9dico para adultos-INGL\u00c9S\" alt=\"Adult Medical History Form\" data-ext=\"pdf\"\/>\n         <span class=\"title\">Formulario de historial m\u00e9dico para adultos-INGL\u00c9S<\/span>\n      <\/a>\n   <\/div>\n   <div class=\"document-icon\">\n      <a href=\"https:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Authorization-for-Release-of-Information-ENGLISH.pdf\" target=\"_self\">\n         <img decoding=\"async\" src=\"https:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Authorization-for-Release-of-Information-ENGLISH-thumb.png\" title=\"Autorizaci\u00f3n para Divulgaci\u00f3n de Informaci\u00f3n\" alt=\"Authorization for Release of Information\" data-ext=\"pdf\"\/>\n         <span class=\"title\">Autorizaci\u00f3n para Divulgaci\u00f3n de Informaci\u00f3n<\/span>\n      <\/a>\n   <\/div>\n   <div class=\"document-icon\">\n      <a href=\"https:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Designation-of-Personal-Representative-ENGLISH.pdf\" target=\"_self\">\n         <img decoding=\"async\" src=\"https:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Designation-of-Personal-Representative-ENGLISH-thumb.png\" title=\"Designaci\u00f3n de Representante Personal\" alt=\"Designation of Personal Representative\" data-ext=\"pdf\"\/>\n         <span class=\"title\">Designaci\u00f3n de Representante Personal<\/span>\n      <\/a>\n   <\/div>\n   <div class=\"document-icon\">\n      <a href=\"https:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Medicaid-Application-ENGLISH.pdf\" target=\"_self\">\n         <img decoding=\"async\" src=\"https:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Medicaid-Application-ENGLISH-thumb.png\" title=\"Solicitud de Medicaid\" alt=\"Medicaid Application\" data-ext=\"pdf\"\/>\n         <span class=\"title\">Solicitud de Medicaid<\/span>\n      <\/a>\n   <\/div>\n\n<\/div>\n<div class='document-icon-row'>\n   <div class=\"document-icon\">\n      <a href=\"https:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Patient-Master-File-and-Income-Information-ENGLISH.pdf\" target=\"_self\">\n         <img decoding=\"async\" src=\"https:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Patient-Master-File-and-Income-Information-ENGLISH-thumb.png\" title=\"Archivo Requisito de Pacientes e Informaci\u00f3n de Ingresos\" alt=\"Patient Master File and Income Information\" data-ext=\"pdf\"\/>\n         <span class=\"title\">Archivo Requisito de Pacientes e Informaci\u00f3n de Ingresos<\/span>\n      <\/a>\n   <\/div>\n\n<\/div>\n<\/div>\n\n<img decoding=\"async\" class=\"aligncenter wp-image-375 size-full\" src=\"http:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Line-Divider_zpsnzpwyzh6.png\" alt=\"Line-Divider_zpsnzpwyzh6\" width=\"500\" height=\"200\" srcset=\"https:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Line-Divider_zpsnzpwyzh6.png 500w, https:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Line-Divider_zpsnzpwyzh6-300x120.png 300w, https:\/\/fcpchealth.com\/wp-content\/uploads\/2016\/02\/Line-Divider_zpsnzpwyzh6-214x86.png 214w\" sizes=\"(max-width: 500px) 100vw, 500px\" \/>\n<h3 class=\"r\">Espa\u00f1ol<\/h3>\n\n<!-- Generated using Document Gallery. 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