Forms

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schuylkill

Click the appropriate link below to download and print the appropriate form.

Note: There are separate forms for Schuylkill Medical Center East Norwegian Street and Schuylkill Medical Center South Jackson Street.

When completed, follow the instructions on the form to send to the appropriate Medical Center.

Schuylkill Medical Center East Norwegian Street - Records Request Form

Schuylkill Medical Center South Jackson Street - Records Request Form

Electronic Data Authorization Form

Patient Portal Authorization for Granting Proxy Access