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Most Requested / Policy / Schedule / Forms

Most Requested

2023 VOYA SUMMARY ANNUAL REPORT

Uploaded: 4-25-24

Download PDF64 KB

APRIL 2025

Updated: 4/16/25

Download PDF156 KB

April Confirm 2025

Released: 03/26/2025

Download PDF191 KB

Confidentiality Agreement for Visitors in Clinical Areas

Released: 12/17/24

Download PDF32 KB

Email Disclosure

Released: 12/13/24

Download PDF22 KB

Employee Emails

Updated 12/12/24

Download PDF83 KB

Fax Cover Sheet – HNA

Released: 12/13/24

Download PDF97 KB

Fax Cover Sheet – MV

Released: 12/13/24

Download PDF92 KB

Herpes Prophylaxis Protocol

Released: 3-21-24

Download PDF30 KB

HIPAA Privacy Form

Released 1/1/25

Download PDF93 KB

History & Ocular Exam

Form to use when NextGen is down!

Download PDF57 KB

HNA Phone Extensions

Updated 8/16/24

Download PDF105 KB

HNA Policies

Updated 11/7/24

Download PDF482 KB

Insurance Verification Form 212

Uploaded: 4/2/25

Download PDF123 KB

Lab Orders Form

Updated: 9/5/23

Download PDF59 KB

MAY 2025

Updated: 4/14/25

Download PDF159 KB

May Confirm Calendar

4/14/2025

Download PDF227 KB

New Patient Forms

Released: 11/7/24

Download PDF241 KB

No insurance facility/physician fees

Updated: 3/10/25

Download PDF127 KB

Patient Privacy Forms

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Surgery/Post-Op Dates

Released: 6/26/24

Download PDF84 KB

Vacation Picks 2025

Please fill out and return to Becca by November 15th even if you are not picking any time in advance.

Released 11/6/24

Download PDF56 KB

Policy

Physician Phone Numbers

Updated 1/8/2021

Download PDF67 KB

Plaquenil Treatment Policy

Updated 8/25/2020

Download PDF97 KB

Privacy Notice

Released: 11/21/23

Download PDF138 KB

Scheduling Policy

Released 8/24/21

Download PDF232 KB

Wait List Policy

Released 8/24/21

Download PDF123 KB

Schedule

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Forms

COVID Consent

Updated 7/08/2021

Download PDF

Desk Information

Released 5/5/22

Download PDF108 KB

Emergency Contact Form

Released 3/30/23

Download PDF129 KB

Event Report, Accident, Injury Fall Incident Report HNA

Date: 4/13/23

Download PDF135 KB

Excuse for Accompanying Patient

Released 7/2/21

Download PDF66 KB

Excuse Work/School Form 153

Released 7/19/21

Download PDF112 KB

Imaging Orders Form

Released 7/8/21

Download PDF99 KB

Key Form

Revised 8/19/22

Download PDF101 KB

Please make check payable to HNA

Released: 4/19/23

Download PDF59 KB

Record Release From HNA

Updated 4/17/23

Download PDF107 KB

Record Release To HNA

Updated 4/17/23

Download PDF105 KB

Request for Time off

Uploaded 4/19/23

Download PDF42 KB

Return Pt. After 3 Years

09/21/2023

Download PDF101 KB

Ring Central Phone Cheat Sheet

Updated 2/3/21

Download PDF183 KB

Surgery Center Covid Questions

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Versum Visual Acuity & Color Testing Form

Released 4/5/22

Download PDF47 KB