Patient Forms

Pediatric Registration packets

• UBCP Pediatric Registration Packet 0-11 yrs old
• UBCP Pediatric Registration Packet 12-17 yrs old

Pediatric Patient Registration

• Pediatric Registration Form
  
• 儿童患者登记表 - Chinese
• Registro Para Pacientes de Pediatría - Español

Pediatric Consent

• Consent to Treatment of Minor
• Consentimiento Para el Tratamiento de Menores - Español 

Pediatric Terms & Conditions

• Terms & Conditions
• Terms & Conditions  - Español 

Adult Patient Registration

• Adult Registration Form
  
• Registro Para Paciente Adulto - Español
• 成人病人登记 - Chinese
• đăng ký bệnh nhân người lớn - Vietnamese

PDC Registration Form

• PDC Registration Form
• PDC Formulario de registro - Español
• PDC 报名表格 - Chinese
• PDC Mẫu đăng ký - Vietnamese

Adult Terms & Conditions

• Terms & Conditions
• Términos y Condiciones de Registro, Servicios Médicos y Acuerdo Financiero - Español
• Terms & Conditions - Vietnamese

Privacy Practices

• Notice of Privacy Practices Acknowledgement
• Recibo de Reconocimiento Del Aviso De Privacidad - Español
• Notice of Privacy Practices
• Aviso de Prácticas de Privacidad - Español
• 隱私權實施條例通知 加州大學三藩市分校UCSF 健康體系 - Chinese

My Chart Account

• UBCP MyChart Proxy Authorization Patient's Age 0 - 11 Yrs. Old
• UBCP MyChart Proxy Authorization Granting Proxy Access to Parent/Guardian on behalf of an Adolescent (Age 12 - 17 years)
  

Authorization for Release of Health Information

• Authorization for Release of Health Information
• Authorization for Release of Health Information - Español