Lawrence Park OB/GYN

• Patient registration form
• Adult comprehensive health assessment (or use the large print version of the health assessment)
• Administrative authorizations
• Care Everywhere authorization form
• Medicare secondary provider questionnaire
• Medicare health risk assessment form
• Medicare depression screening form
• Patient demographic data sheet
• Instructions for authorization to disclose protected health information (PHI)
• Authorization to disclose protected health information (PHI)
• Main Line Health notice of privacy practices
• Acknowledgement of receipt – MLH notice of privacy practices
• Non-discrimination and availability of services notice

To request a copy of your medical records: Authorization for release of medical information form

For your convenience, we have also included links to our three most commonly requested forms:

• PIAA form for sports participation
• PA driver's license physical form DL-180
• PennDot handicap parking placard application