Jeanette Ruby, M.D.
Medical Counseling and Support Services
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Patient Advocacy
About Jeanette Ruby
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Forms & Resources
Client forms and resources
Forms:
Scope of practice. Statement of understanding.doc
New client information.doc
New client addendum. Other health service providers.doc
Financial agreement.doc
JR. Authorization to request information.doc
JR. Authorization to disclose information.doc
Authorization for electronic transfer of PHI.doc
JR. Request restricted PHI use or disclosure.doc
JR. Notice of privacy practices.doc
Receipt or declination of notice of privacy practices.doc
Resources:
WA State patient's bill of rights.pdf
Advocates Help Patients Navigate Health Care Maze
, by Richard Knox
NPR: Patient Advocates: Tips From You
, by Richard Knox
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