You will be asked to read and sign a Privacy Statement at every 
Doctor's Office after April 14, 2003.

Here is the Cook's Privacy Statement:
Privacy Statement

Then you will have to sign an agreement that you have been 
given it and read it.  This hassle was legislated by Congress 
and has to be done once at every office.  You can print out this 
agreement and sign it and mail or bring it in to the office.  Or 
we will be giving you one to sign at the office.  Sorry about 
these government troubles.
Privacy Agreement

Authorization to release Medical Information
This is the form so that you can have someone else pick up
any medical information, shot records, or prescriptions.
Print this form, fill it out and send it in to us at Cook Children's Clinic.
Authorization to Release Information

If you want to request your previous doctor to send your medical records
to this office then fill out this request and mail it to your previous physician's office.
Authorization to Obtain Medical Information

New Patient Forms:  You will need to fill these out at your first office visit.  You can print these out at home and fill them out ahead of time.  Then bring them in with you to the office. 

1. Patient Registration Information:  Patient Reg Info pdf

2. Patient Data History Form:  History Form

If you want someone else other than the parent or gardian to bring the minor for medical care, then
you need to have this form signed and in the patient's chart or have them bring it with them.
Non-Parent Authorization Consent Form:  Authorization pdf

 

Every Patient has to sign these government HIPPA forms also:

1.  Privacy Statement must be read and then a Privacy Agreement has to be signed.