Patient Notification Records of Advance Directives

Patient Notification Records of Advance Directives

  • ADVANCED DERMATOLOGY LASER & COSMETIC SURGERY
    1220 Avenue P                                         Brooklyn, NY 11229
    718-375-7546 (Tel)                                     718-376-6475 (Fax)
               CONSENT FOR OUTPATIENT TREATMENT
  • PATIENT NOTIFICATION RECORD OF CONFIDENTIALITY POLICY AND ADVANCE DIRECTIVES

  • THE PATIENT NAMED ABOVE OR THE PATIENT’S FAMILY OR REPRESENTATIVE HAS BEEN GIVEN THE FOLLOWING NOTICES AS REQUIRED BY STATE AND FEDERAL REGULATIONS:


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