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Patient Forms

A

Advance medical directive
Médicas anticipadas de Virginia en Espanol

Authorization to release medical records

C

CDC Immunization Schedule: Birth through 18 years
CDC Immunization Schedule: Catch-up Schedule
CDC Immunization Schedule: Adult Schedule, by Vaccine and Age Group
CDC Immunization Schedule: Recommended Vaccinations Indicated for Adults Based on Medical and Other Indications
CDC Immunization Schedule: Adult Contraindications and Precautions
Confidentiality and Security Agreement

D

Daisy Award Nurse Brochure - Mary Washington Hospital
Daisy Award Nurse Nomination Form - Mary Washington Hospital
Daisy Award Nurse Brochure - Stafford Hospital
Daisy Award Nurse Nomination Form - Stafford Hospital
Diabetes Management Patient Packet (Cosner's Corner)
Diabetes Management Pregnant Patient Packet (Cosner's Corner)
Diabetes Management Patient Packet (Stafford Hospital)
Diabetes Management Pregnant Patient Packet (Stafford Hospital)

F

Financial Assistance Application (English)
Solicitud de Ayuda Financiera
Floor Plan - Mary Washington Hospital

M

Mary Washington Eye Care Center patient history form
Mary Washington Eye Care Center patient information form
Map - Mary Washington Hospital campus
Map - Stafford Hospital campus
Medical records - authorization to release
Medical records and x-ray request (Mary Washington Orthopedics)

N

Nutrition Therapy (Cosner's Corner)
Nutrition Therapy (Stafford)
Nutrition Therapy - Pediatric (Cosner's Corner)
Nutrition Therapy - Pediatric (Stafford)

O

Online Donations

P

Patient Guide - Mary Washington Hospital
Patient Guide - Stafford Hospital
Patient Intake Form (Mary Washington Cardiology)
Patient Intake Form (Mary Washington Medical Group)
Patient rights and responsibilities - Mary Washington Hospital
Patient rights and responsibilities - Stafford Hospital
Patient rights and responsibilities - Fredericksburg Ambulatory Surgery Center
Derechos y responsibilidades del paciente - Mary Washington Hospital
Derechos y responsibilidades del paciente - Stafford Hospital

S

Safe Haven
System Access Request (PDF)
Sleep Disorder Questionnaire
Stafford Hospital campus map

W

Wound Healing Services patient assessment form

Y

Your right to decide
Su derecho a decidir

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