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BCC Forms

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Boundary Community Clinics Patient Forms

Completed forms can be emailed to [email protected] or Fax (208) 267-3757.
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Authorization to Disclose Protected Health Information
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Consent for Treatment
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Health History Questionnaire
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Medical Information Release Form
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New Patient Information Packet – All Forms
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No Show Policy
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[av_toggle title=’Patient Information Sheet’ tags=” custom_id=” av_uid=’av-2pbwd’]
Patient Information Sheet
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Portal Access Consent and Agreement
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Prescription Policy
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Request for Medical Records
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Need to schedule an appointment?
Call (208) 267-3655
Fax (208) 267-3757
Lucero Medical Services Building
6641 Kaniksu Street, Bonners Ferry, ID 83805
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