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Salem Clinic registration

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Resources

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
Ultrasound - Vascular
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

Best Local Medical Practice - GOLD	Statesman's Journal Best of the Mid-Valley Gold 2018	Statesman's Journal Best of the Mid-Valley Silver 2017	Statesman's Journal Best of the Mid-Valley Gold 2016	Statesman's Journal Best of the Mid-Valley Gold 2014	Statesman's Journal Best of the Mid-Valley Gold 2013	Statesman's Journal Best of the Mid-Valley Gold 2012
Current Accreditation in Mammography, Echocardiography, MRI, & CT	Current Accreditation in Breast Imaging	Medical Group Association (AMGA) Acclaim Award for quality of diabetes care	Angie's List 2014 Super Service Award Winner	Best Practice Designation by MGMA for 14 years	Tier 5 Patient Centered Primary Care Home	American Board of Magnetic Resonance Safety

Best of the Willamette Valley GOLD 2020

Best of the Willamette Valley GOLD 2020

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 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 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 Place to Work – SILVER
Best Doctor - SILVER

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

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Locations

Main Clinic
Keizer
South
Union St

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