EC
Emily Carter
Active
MRN: MRN-100901·DOB: 1999-08-25 (Age 26)
LOC: Main Campus — Residential
Program: Behavioral Health
Clinician: Sarah Chen
Allergies:
Latex
Insurance: Verified
Pending Forms
0 pending
No pending forms.
Completed Forms
4
Treatment Consent
Consent for behavioral health treatment
Completed 2026-01-15 · Signed by Maria Santos
Completed
Release of Information (ROI)
Authorization for exchange of health information with PCP Dr. Ramos
Completed 2026-01-15 · Signed by Maria Santos
Completed
Telehealth Consent
Consent for telehealth services and virtual visits
Completed 2026-01-16 · Signed by Maria Santos
Completed
Financial Agreement
Acknowledgment of financial responsibility and payment terms
Completed 2026-01-15 · Signed by Maria Santos
Completed