Resources and Forms
General Forms
• Request to Inspect and/or Receive Copies of Clinical Record
• Incident Report Form
• Emergency Use of Physical Management Form
• OnPoint Sliding Fee Scale
If you are uninsured or underinsured, you may be eligible for financial assistance under the Federal Poverty Guidelines (FPG). The scale is based on gross income and family size. Depending on where you fall on the scale will determine what your monthly ability-to-pay will be, if eligible.
Freedom of Information Act Forms
Freedom of Information Act Summary
Freedom of Information Act Request for Public Record
Freedom of Information Act Request for Extension
Freedom of Information Act Request for Detailed Cost Itemization
Freedom of Information Act Notice of Denial
Freedom of Information Act Appeal of Denial
Freedom of Information Act Appeal of Excess Fees