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Recovery Now

Berlin 856-767-6044

Recovery Now

About Us
Services
Office Info
Resources
- FAQs
Location

Forms

All Your Patient Forms In One Place

Annual Patient Packet Forms

Adult Patient Registration (PDF)

Annual Consent and Acknowledgement (PDF)

Aviso de Prácticas de Privacidad (PDF)

Consentimiento y Reconocimiento Anual (PDF)

Notice of Privacy Practices (PDF)

Registro de Pacientes Adultos (PDF)

A man is sitting at a table completing forms with a laptop open in front of him

Adult Patient Registration (PDF)

Annual Consent and Acknowledgement (PDF)

Aviso de Prácticas de Privacidad (PDF)

Consentimiento y Reconocimiento Anual (PDF)

Notice of Privacy Practices (PDF)

Registro de Pacientes Adultos (PDF)

ABN – Advanced Beneficiary Notice of Noncoverage (Medicare only) (PDF)

ABN – Aviso Anticipado de No Cobertura Para el Beneficiario (Medicare Solamente) (PDF)

ABN - Form Instructions

Authorization for Use & Disclosure of Protected Health Information (PHI) (PDF)

(Medical Records Release)

Autorización para el uso y divulgación de información médica protegida (PHI) (PDF)

Cancellation of Prior Health Information Exchange (HIE): Opt-Out (PDF)

Cancellation of Prior SureScripts: Opt-Out (PDF)

Case Registration (PDF)

Estimated Cost: Out-of-Network Services (PDF)

Formulario de responsabilidad financiera del paciente de Advocare

Healow Trifold (PDF)

Health Information Exchange (HIE): FAQs (PDF)

Health Information Exchange (HIE): Opt-Out (PDF)

Informed Consent: In-Office Procedures (PDF)

Notice of Privacy Practices - Arabic

Notificación de divulgación a profesional/proveedor fuera de la red

Patient Consent to Draw/Test Blood (PDF)

Patient Financial Responsibility (PDF)

Patient Photograph/Video Information Release Authorization (PDF)

Patient Portal Proxy Authorization (Age 18+)

Patient Portal: FAQs (PDF)

Patient Portal: Flyer (PDF)

Practice & Payment Philosophy (PDF)

Professional/Provider: Out-of-Network Disclosure Notification (PDF)

Recordatorio de Seguro Para Recién Nacidos (PDF)

Restriction of Disclosure to Health Plan (PDF)

SureScripts: Opt-Out (PDF)

Patient Forms

ABN – Advanced Beneficiary Notice of Noncoverage (Medicare only) (PDF)

ABN – Aviso Anticipado de No Cobertura Para el Beneficiario (Medicare Solamente) (PDF)

ABN - Form Instructions

Authorization for Use & Disclosure of Protected Health Information (PHI) (PDF)

Autorización para el uso y divulgación de información médica protegida (PHI) (PDF)

Cancellation of Prior Health Information Exchange (HIE): Opt-Out (PDF)

Cancellation of Prior SureScripts: Opt-Out (PDF)

Case Registration (PDF)

Estimated Cost: Out-of-Network Services (PDF)

Formulario de responsabilidad financiera del paciente de Advocare

Healow Trifold (PDF)

Health Information Exchange (HIE): FAQs (PDF)

Health Information Exchange (HIE): Opt-Out (PDF)

Informed Consent: In-Office Procedures (PDF)

Notice of Privacy Practices - Arabic

Notificación de divulgación a profesional/proveedor fuera de la red

Patient Consent to Draw/Test Blood (PDF)

Patient Financial Responsibility (PDF)

Patient Photograph/Video Information Release Authorization (PDF)

Patient Portal Proxy Authorization (Age 18+)

Patient Portal: FAQs (PDF)

Patient Portal: Flyer (PDF)

Practice & Payment Philosophy (PDF)

Professional/Provider: Out-of-Network Disclosure Notification (PDF)

Recordatorio de Seguro Para Recién Nacidos (PDF)

Restriction of Disclosure to Health Plan (PDF)

SureScripts: Opt-Out (PDF)

Required Forms

Advocare Non-Discrimination Notice (PDF)

Advocare Payer List (PDF)

Explanation of Individual's Right to Appeal Health Insurance Determinations (PDF)

(New Jersey Only)

Grievance Procedure (PDF)

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