Policies & Forms | Boston Children's Health Physicians

If you have a potential compliance issue to report, please call our confidential compliance hotline at 914-614-4100.

Please be aware that these forms are provided for informational purposes only. Your doctor’s office will inform you of the specific forms required and their preferred method of completion.

Notice of Privacy Practices
Notice of Privacy Practices (Spanish)
Patient Financial Policy
Patient Financial Policy (Spanish)
Patient Demographic and Registration Form
Patient Demographic and Registration Form (Spanish)
HIPAA Consent and Disclosure Form for over 18 years
HIPAA Consent and Disclosure Form for over 18 years (Spanish)
Consent to Treat Patients Without Parent or Relative

Code of Conduct
Code of Conduct (Spanish)
Compliance Policies and Procedures
Compliance Policies and Procedures (Spanish)
Surprise Billing Policy
Surprise Billing Policy (Spanish)
Vaccine Policy
Vaccine Policy (Spanish)
Connecticut Authorization to Release Medical Records
New York State Authorization to Release Medical Records
New York State Authorization to Release Medical Records (Spanish)

Boston Children's Health Physicians Corporate Compliance Policies and Procedures