{"id":1577,"date":"2022-10-04T12:00:49","date_gmt":"2022-10-04T12:00:49","guid":{"rendered":"https:\/\/www.toplinemd.com\/ana-hpmd\/?page_id=1577"},"modified":"2023-04-13T07:11:38","modified_gmt":"2023-04-13T07:11:38","slug":"forms","status":"publish","type":"page","link":"https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-margin-top:40px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last\" style=\"--awb-bg-size:cover;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-one\" style=\"--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h1 class=\"fusion-title-heading title-heading-center fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:60;line-height:1;\">Forms<\/h1><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling service-single-first-sec telemedicine\" style=\"--awb-background-position:left top;--awb-border-sizes-top:0px;--awb-border-sizes-bottom:0px;--awb-border-sizes-left:0px;--awb-border-sizes-right:0px;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:3%;--awb-padding-right:0px;--awb-padding-bottom:3%;--awb-background-color:#faf9f9;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1216.8px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:40px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:30px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><ul class=\"form-list\">\n\t<li><a href=\"\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2020\/09\/Authorization-to-Disclose-PHI-Form-ENGLISH-Revised.doc.pdf\" target=\"_blank\" rel=\"noopener\">Medical Release Form English<\/a><\/li>\n\t<li><a href=\"\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2020\/09\/Authorization-to-Disclose-PHI-Form-SPANISH-Revised.docx.pdf\" target=\"_blank\" rel=\"noopener\">Medical Release Form Spanish<\/a><\/li>  \n\t<li><a href=\"\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2020\/02\/PrenatalVisitForm.pdf\" target=\"_blank\" rel=\"noopener\">Prenatal Visit<\/a><\/li>\n<\/ul><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:40px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:30px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><ul class=\"form-list\">\n\t<li><a href=\"\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2020\/08\/Registration-forms-Ana-HPMD.pdf\" target=\"_blank\" rel=\"noopener\">Registration Forms<\/a><\/li>\n\t<li><a href=\"\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2020\/03\/Telehealth-Informed-Consent.pdf\" target=\"_blank\" rel=\"noopener\">Telehealth Informed Consent<\/a><\/li>\n<\/ul><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 hundred-percent-fullwidth non-hundred-percent-height-scrolling fusion-equal-height-columns logos-footer\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:10px;--awb-padding-bottom:0px;--awb-padding-left:60px;--awb-background-color:#f0f3f6;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_2 1_2 fusion-one-half fusion-column-first\" style=\"--awb-padding-top:40px;--awb-bg-blend:overlay;--awb-bg-size:cover;width:50%;width:calc(50% - ( ( 0 ) * 0.5 ) );margin-right: 0px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-image-element in-legacy-container\" style=\"--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-1 hover-type-none\"><a class=\"fusion-no-lightbox\" href=\"\/ana-hpmd\/\" target=\"_self\" aria-label=\"Ana HPMD Logo\"><img decoding=\"async\" width=\"270\" height=\"100\" alt=\"Doctor Ana Logo\" src=\"https:\/\/www.toplinemd.com\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2020\/06\/Ana-HPMD-Logo.png\" class=\"img-responsive wp-image-1133\" srcset=\"https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2020\/06\/Ana-HPMD-Logo-200x74.png 200w, https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2020\/06\/Ana-HPMD-Logo.png 270w\" sizes=\"(max-width: 800px) 100vw, 270px\" \/><\/a><\/span><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_2 1_2 fusion-one-half fusion-column-last\" style=\"--awb-padding-top:40px;--awb-bg-blend:overlay;--awb-bg-size:cover;width:50%;width:calc(50% - ( ( 0 ) * 0.5 ) );\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-image-element fusion-image-align-left in-legacy-container\" style=\"text-align:left;--awb-max-width:270px;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-2 hover-type-none\" style=\"margin-right:25px;float:left;\"><a class=\"fusion-no-lightbox\" href=\"https:\/\/www.toplinemd.com\/why-topline-md\/\" target=\"_blank\" aria-label=\"TopLine MD-RegisterR_Stacked_Logo_rgb_color\" rel=\"noopener noreferrer\"><img decoding=\"async\" width=\"1576\" height=\"376\" src=\"https:\/\/www.toplinemd.com\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color.png\" alt class=\"img-responsive wp-image-1872\" srcset=\"https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-200x48.png 200w, https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-400x95.png 400w, https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-600x143.png 600w, https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-800x191.png 800w, https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-1200x286.png 1200w, https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-content\/uploads\/sites\/7\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color.png 1576w\" sizes=\"(max-width: 800px) 100vw, 600px\" \/><\/a><\/span><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":13,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-1577","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-json\/wp\/v2\/pages\/1577","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-json\/wp\/v2\/users\/13"}],"replies":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-json\/wp\/v2\/comments?post=1577"}],"version-history":[{"count":0,"href":"https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-json\/wp\/v2\/pages\/1577\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.toplinemd.com\/pediatrics\/ana-hpmd\/wp-json\/wp\/v2\/media?parent=1577"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}