FORMS Advance Directive Form & Information An Advance Directive is a legal document that outlines a person's preferences for medical care if they are unable to communicate their wishes. It can also name someone to act on the patient's behalf if they are unable to do so. PMC asks all patients to complete an Advance Directive and share it with us, your other health care providers, family, and close friends.
Power of Attorney Form A Power of Attorney is a legal document that allows you to give the authority to another person to make decisions on your behalf. It can be tailored to your specific needs and can be appointed immediately or you can make the appointment effective only if you become disabled.
Release of Medical Information (ROI) A Release of Information (ROI) is a document that authorizes PMC, or others, to disclose or obtain your health information. An ROI gives you the opportunity to decide what material you want released or obtained from your medical file, who you want it delivered to, how long the data can be issued, and under what guidelines it is released.
Occupational Health Requisition An Occupational Health Requisition is for employers to request medical services such as vaccines, physicals, and post-exposure testing to be done for their employee and is paid for by the employer.
HEALTH INFORMATION EXCHANGE Petersburg Medical Center is a CommonWell Alliance partner. Being a part of this health information exchange (HIE) means we are part of national network of organizations aligned to streamline the secure sharing of health data with a goal of improving care coordination and health outcomes. It allows your health care providers to use secure, electronic methods to share your recent medical information with other providers, hospitals, labs and other providers participating in your care. CommonWell FAQs CommonWell Opt Out - Back in Form