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CLINIC FORMS

The forms on this page are provided in Adobe PDF format, please download the form(s) you need, fill it in and return it.

If you need Adobe Reader to open the forms you can download it here.

Online Patient Registration Form – English/Spanish

Good Faith Estimate Program

Authorization to Release Patient Health Information to CHCW

Authorization to Release Patient Health Information From CHCW to External Entity 

Clinics

  • CHCW Home
  • CWFM Yakima
  • CHCW Ellensburg
  • Ellensburg Dental
  • Naches Medical Clinic
  • Highland Clinic
  • Yakima Pediatrics
  • CWFM Residency
  • Senior Residential Care

About CHCW

  • News
  • Patient Centered Medical Home
  • Employment
  • Request for Proposals

Resources

  • Regulatory Updates
  • NI Login
  • Immunization Schedule
  • Electronic Medical Records
  • Apple Health
  • Notification of Privacy Practice
  • Notificatión de Prácticas de Privacidad

Contact

  • Yakima CWFM
  • Yakima Pediatrics
  • CHCW Ellensburg
  • Ellensburg Dental
  • Highland Clinic
  • Naches Medical Clinic
  • Senior Residential Care

FTCA Notice

Community Health of Central Washington receives medical malpractice coverage provided by the Federal Tort Claims Act (FTCA).

Community Health of Central Washington recibe cobertura de negligencia medica proporcionada por la Ley Federal de Demandas por Ofensas (FTCA).

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