SR
Sofia Ramirez
Active
MRN: MRN-100755·DOB: 1993-06-14 (Age 32)
LOC: Main Campus — Residential
Program: Behavioral Health
Clinician: David Washington
Allergies:NKDA
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