Instructions for setting up the HEALOW cellpone/tablet app
Medical Records Release (to EFH)
Allows Evergreen Family Health to obtain medical Information from another medical office or other source.
Medical Records Release (From EFH)
Allows Evergreen Family Health to send medical information from your record to a third party such as an employer, insurance company, or other health care provider.
Records Release (MV Accident)
Authorization for medical record release in the event of a motor vehicle accident.
Records Release (Workers Comp)
Allows EFH to obtain medical Information in the event of Workers Compensation filing.
Permission to discuss medical care
Allows EFH to share your medical care with family members and others of your choosing.
Vermont Advanced Directive
Living Wills and advanced directives describe your end-of-life care. EFH advises that all adults have an advanced directive on file.
Vermont Appointment of a Health Care Agent
Enables you to appoint a health care agent who will be authorized to make medical decisions for you if you are unable to speak for yourself.
New Patient Adult Health Database
Form for initial health exam – “Complete Physical”
Existing Patient Adult Health Database
Form for health exam
Form for Benzo/stimulant informed consent
Form for Narcotic Informed Consent – Chronic Pain