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Forms - English

Administration

Acknowledgement and Consent
Nondiscrimination Policy
Release of Information
Release Medical Information to a Family Member, Friend or Legal Representative
Permission to Treat Letter
Medical Records Amendment Correction Request Form
Text Message Consent Form

Medical Information

Chronic Care Management Services
Immunization Schedule - Adult
Immunization Schedule - Adolescent
Immunization Schedule - Pediatric

Behavioral Health Resources

Behavioral Health Resource Guide
ADHD Testing & Mental Health Evaluations
Substance Abuse & Mental Health Services
Community Resource Guide

Advance Care Planning

Oregon Advance Directive for Health Care

Imaging

CT Information
DEXA
Echocardiogram
Ultrasound
Ultrasound - OB
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Mammography
Open MRI
MRI

Questionnaires

Patient Health History Questionnaire
Patient Health History Update

OB / GYN

Common Concerns of Pregnancy

Forms - Spanish

Administración

Reconocimiento Y Consentimiento
Autorización Para Divulgar Información Médica
Permiso Para Divulgar Información Médica Confidencial
Notificación al Beneficiario

Información Médica

Materiales educativos de salud multilingües de Medline
Hoja de datos de Paxlovid

Cuestionarios

Cuestionario del historial de salud del paciente
Actualización del historial de salud del paciente

OB / GYN

Preocupaciones Comunes del Embarazo

Forms - Russian

Администрация

Уведомление о Соблюдении Конфиденциальности

Общая информация о здоровье

Многоязычные материалы по медицинскому образованию Medline

Анкеты

Анкета-опросник о медицинской истории пациента
Обновление истории здоровья пациента

Medline Multilingual Health Education Materials
Substance Abuse & Mental Health Services
American College of Obstetricians and Gynecologists
CDC Travelers' Health
Choose My Plate
Diabetes
Family Doctor
Healthfinder
Salem Hospital Bariatric Surgery Center
QuitNow.net
American Association of Family Physicians
211info.org

Salem Clinic Best Local Medical Practice

Best Local Medical Practice - GOLD

Salem Clinic Best of the Mid-Valley Gold 2018

Statesman's Journal Best of the Mid-Valley Gold 2018

Salem Clinic Best of the Mid-Valley Silver 2017

Statesman's Journal Best of the Mid-Valley Silver 2017

Salem Clinic Best of the Mid-Valley Gold 2016

Statesman's Journal Best of the Mid-Valley Gold 2016

Salem Clinic Best of the Mid-Valley Gold 2014

Statesman's Journal Best of the Mid-Valley Gold 2014

Salem Clinic Best of the Mid-Valley Gold 2013

Statesman's Journal Best of the Mid-Valley Gold 2013

Salem Clinic Best of the Mid-Valley Gold 2012

Statesman's Journal Best of the Mid-Valley Gold 2012

Salem Clinic Accreditation in Mammography, Echocardiography, MRI, & CT

Current Accreditation in Mammography, Echocardiography, MRI, & CT

Salem Clinic Current Accreditation in Breast Imaging

Current Accreditation in Breast Imaging

Salem Clinic Award for quality of diabetes care

Medical Group Association (AMGA) Acclaim Award for quality of diabetes care

Salem Clinic Super Service Award Winner

Angie's List 2014 Super Service Award Winner

Salem Clinic Best Practice Designation by MGMA

Best Practice Designation by MGMA for 14 years

Salem Clinic Patient Centered Primary Care

Tier 5 Patient Centered Primary Care Home

Salem Clinic American Board of Magnetic Resonance Safety

American Board of Magnetic Resonance Safety

Best Medical Facility - GOLD

Best Medical Facility – GOLD
Best Urgent Care/Walk-In Clinic – GOLD
Best Women’s Clinic – SILVER
Best Men’s Health – SILVER
Best Pain Management Clinic - SILVER

Best Medical Facility - GOLD

Best Medical Facility - GOLD
Best Urgent Care/Walk-In Clinic - GOLD
Best Place to Work – SILVER
Best Doctor - SILVER

Best Medical Facility - GOLD

Best Medical Facility - GOLD
Best Urgent Care/Walk-In Clinic - GOLD
Best Mental Health Services – GOLD
Best Pain Management Clinic – GOLD
Best Doctor - SILVER

Best Medical Facility - GOLD

Best Medical Facility - GOLD
Best Urgent Care/Walk-In Clinic - GOLD
Best Women’s Clinic - GOLD

Best Medical Facility - GOLD

Best Medical Facility - GOLD
Best Urgent Care/Walk-In Clinic - GOLD
Best Women’s Clinic - GOLD
Best Doctor – GOLD
Best Place to Work – GOLD

Best of the Willamette Valley GOLD 2020

Best of the Willamette Valley GOLD 2020

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