Forms

Consent for Treatment of a Minor

This form can be downloaded from your computer. If gives authorization to the individual taking care of your children to allow emergency treatment in case it is needed.

Download form (8kb)

Universal Medication Form

Download this form to keep track of your medications, dosages, and allergies. You can keep this on file within your computer (Adobe Reader required) and print it out for your next visit to your doctor or to the hospital. You can also click the button on the bottom of the page to submit it securely to Mercer Health. Check to make sure the information is correct. Be sure to update this form as your medications change.

Download form (72kb)

Personal Health Record

Once this form has been downloaded on your computer, you can fill it out within Adobe Reader and print to bring in to your next visit, or click the button on the bottom of the page to submit it securely to Mercer Health. Check to make sure “Personal Health Record” information is correct.

Download form (684kb)