119 Amicks Ferry Road Chapin, SC 29036 803.932.2200 803.945.4445 803.932.2225 (fax)

© 2006-2008 chapinpediatrics.com - All rights reserved

For questions pertaining to the website or to report inactive links, please click here

Forms

 

 

Patient Information Form

 

HIPAA - Notice of Privacy Practices

 

Authorization For Release of

Protected Health Information

TO Chapin Pediatrics

 

Authorization For Release of

Protected Health Information

TO ANOTHER Doctor or Hospital

 

The above forms are in a PDF format.  If you are not able to open it, you will need to download the Adobe PDF reader to do so.  This reader can be downloaded for free by clicking here: ADOBE PDF READER