Broward Community & Family Health Centers, Inc.

Avek ako moun ki malad la ak, otorizatyon moun ki resposab la/ konsantman moun ki avek malad la, broward community & family health centers,inc.,sant pou fasilite tretman ,ak tout dokte, dantis,chirijyen ak tout lot moun kap travay nan domen medical,gen otorizatyon pou yo pefome avek tout fom ekzamen medikal ak tretman ki nesese pou swen malad la pandan pandan pasyan ap kontinye dako poul swiv tretman li nan broward community& family health centers,inc.,ak tout pesonel medikal ki an ako avek li ,san malad la pap kontraye avek medikaman yap ba li pou tretman li.

Metod ke ou kapab peye

  1. Mwen otorize pou yo remet nenpot enfomasyon medical tankou,rezilta tes VIH(SIDA),maladi mantal,ect..ak tout rezilta ki nesese pou pwosesis demand asirans pou lasante kom medicare,Medicaid,konpayi asirans pou dokte,ak tout lot kote ki fasilite swen pou lasante malad yo.mwen dako tou poum remet broward community & family health centers,inc.sant pou fasilite tretman ak tout legal asosye responsab pesonel li yo ki ka inteveni,tout dosiem yo e mwen gen poum rete konfidan avek yo.
  2. Mwen otorize broward community & family health centers ak tout asosyel yo pou yo verifye infomasyon mwen nan men patwon’m.
  3. Mwen otorize peye broward community &family health centers ak tout asosyel yo direkteman tout benefis medikal yo.

Broward Community & Family Health Centers, Inc. is a FTCA deemed facility. This is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n). For further information on our FTCA status, please contact BCFHC Corporate Office at (954) 266-2999.

Contact Us

5010 Hollywood Blvd.
Hollywood, FL 33021

Tel: (954) 266-2999
Fax: (954) 966-3320

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