MS
Maria Santos
Active
MRN: MRN-100234·DOB: 1992-03-15 (Age 34)
LOC: Main Campus — Residential
Program: Behavioral Health
Clinician: Sarah Chen
Allergies:
Penicillin
Sulfa drugs
Insurance: Verified
Pending Forms
0 pending
No pending forms.
Completed Forms
4
HIPAA Acknowledgment
Notice of Privacy Practices acknowledgment and signature
Completed 2026-02-01 · Signed by Patient
Completed
Treatment Consent
Consent for behavioral health treatment
Completed 2026-02-01 · Signed by Patient
Completed
Release of Information (ROI)
Authorization for exchange of health information
Completed 2026-02-01 · Signed by Patient
Completed
Telehealth Consent
Consent for telehealth services and virtual visits
Completed 2026-02-01 · Signed by Patient
Completed