Patient Forms

Advance Directives

See Designating a Patient Advocate.

Authorization to Communicate and Leave Telephone Messages

• Authorization to Communicate and Leave Telephone Messages (PDF, 17KB) -
  Use this form to allow us to leave you more detailed messages or to talk to other people about your health.

Medical Records

• Medical Records Release - Learn how to request copies of your medical record.

Nonopioid Directives

These forms enable you to document your wish to avoid receiving opioid medications while in our hospitals.

• MDHHS-5793 Nonopioid Directive (English)(.dotx, downloads from MDHH website)
• MDHHS-5793-AR Nonopioid Directive (Arabic)(.dotx, downloads from MDHH website)
• MDHHS-5793-SP Nonopioid Directive (Spanish)(.dotx, downloads from MDHH website)

Pediatric Forms

• Consent for Treatment of a Minor Child (PDF, 68 KB) - Sign this form and give it to a babysitter, relative, school chaperone or anyone who is responsible for your child while you are away. That person will need to present this form to get medical, dental or hospital care for your child if you cannot be reached.
• Sports physicals (.pdf, downloads from MHSAA website) - This form is required by many school and private sports programs. Complete the student and parent portions of this form and bring it with you to your scheduled sports physical.