Patient Forms and Information

Planned Parenthood Hudson Peconic is dedicated to ensuring all patients receive high-quality service and have a seamless experience at our health centers. See below for patient forms and information.

Patient Rights and Privacy

Request for Medical Records

To transfer your health records from PPHP to another health facility, please fill out this form.

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HIPAA Privacy Policy

Read PPHP's HIPPA Privacy Policy to learn about our privacy practices concerning health information about our patients.

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Notice of Health Information Privacy Practices

Learn more about how PPHP protects health information about you and circumstance when we may disclose health information.

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Care Everywhere Authorizations and Statuses

Care Everywhere is an electronic record sharing application that allows Planned Parenthood to share and receive your records at the point of care to help make your visit more efficient.

Learn more about different levels of authorization available.

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Heathy Care Proxy

The New York Health Care Proxy Law allows you to appoint someone you trust — for example, a family member or close friend – to make health care decisions for you if you lose the ability to make decisions yourself.

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Telehealth Services Patients' Bill of Rights

As a patient receiving telehealth services in a clinic in New York State, you have rights.

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