Patient Information
Medical Release Form
This Medical Records Release Authorization Form is required for use or disclosure of protected health information. Download the form 
Language assistance
For individuals with limited English proficiency, see here how to access language assistance services. Interpreter services are available at no cost to you.
Patient rights and responsibilities
We can provide better healthcare when you and your family work together as partners with our staff. It is our responsibility to advise you of your rights as a patient. You also have responsibilities in your treatment and care. We urge you to ask questions, be proactive and take an active part in your healthcare plan. If you have questions or concerns, please discuss these with any staff member or contact the surgery center’s Administrator.
Patient Rights & Responsibilities - English
Patient Rights & Responsibilities - Farsi
Patient Rights & Responsibilities - Korean
Patient Rights & Responsibilities - Spanish
Patient Rights & Responsibilities - Vietnamese
Privacy Practices
Privacy Practices - English
Privacy Practices - Farsi
Privacy Practices - Korean
Privacy Practices - Spanish
Privacy Practices - Vietnamese
Making healthcare decisions – advance directives
None of us likes to think about how we would want healthcare delivered to us if we became critically ill or unable to communicate. But it is important to make these essential and very personal decisions – known as advance directives – before
needing them.
- Please read and/or print our Advance Directives Policy
- Visit the webpage "Making Healthcare Decisions" for general information about advance directives and to find official medical advance directive
documents for Virginia, Maryland, the District of Columbia and West Virginia. These documents are are available in eight
languages:
- Amharic
- Arabic
- English
- Farsi
- Korean
- Somali
- Spanish
- Urdu
- Vietnamese