Notice of Privacy Practice
Notice of Privacy Practice
Required for all patients
HIPAA Receipt of Privacy Notice
Required for all patients
HIPAA Permissions
HIPAA Authorization for a Minor
Only required if you want someone else to authorize care for your child (children)
HIPAA Restrictions Form
Only required if you want to place restrictions on your medical records
HIPAA Release of Medical Information
Only required if you want to transfer records into or out of CHDC
HIPAA CHDC Complaint Form
Complaint form to be filed with our company
Heathcare Discount Schedule
2019 Sliding Fee Schedule
Financial Assistance Program Details
Healthcare Discount Information
Please submit your forms using the form below
CARING FOR THE COMMUNITY
Community Health and Dental Care is committed to providing affordable, accessible, quality care for everyone in our community. In order to succeed in our mission, we rely on collaborated efforts from many organizations within our community.