Urgent Care & Primary Care PC
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540-665-0084
2505 Valley Ave, Winchester, VA 22601
Interoperability and Rx History Consent Forms
Interoperability Consent and Rx History Consent
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1. Interoperability Consent:
Providing us access to your Electronic Health Records from participating Hospital System(s) and other Care Center(s) allows us to better serve you by being able to access important health information; for example, your allergies, and recent lab results etc.
I grant permission for Winchester Urgent Care to be able to access my Electronic Health Record(s) from participating Hospital System(s) and other Care Facilitie(s) in information exchange and interoperability of Electronic Health Records.
Initial:
2. Rx History Consent:
Providing us access to your Medication History from Pharmacies allows us to quickly and efficiently document the list of your current medications, assess drug-to-drug/drug-to-allergy interactions and obtain insurance coverage information for your prescriptions.
I grant permission for Winchester Urgent Care to be able to access my Medication History from external databases (like Pharmacies) to better process Medications.
Initial:
Patient/Parent/Guardian Signature:
Date:
Contact Information
Winchester Urgent Care & Primary Care PC
Tel: 540-665-0084
Fax: 540-665-9569
2505 Valley Ave, Winchester, VA 22601
2505 Valley Ave, Winchester, VA 22601
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Contact Information
Winchester Urgent Care & Primary Care PC
Tel: 540-665-0084
Fax: 540-665-9569
2505 Valley Ave, Winchester, VA 22601
2505 Valley Ave, Winchester, VA 22601
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