Resources

• New Patient Packet
• New Women’s Health Patient Packet
• New Pediatric Patient Packet Ages 0-11
• New Pediatric Patient Packet Ages 12-17
• Consent to Treat a Minor
• Statement of Patient Rights, Responsibilities, and Privacy Practices
• Receipt of Privacy Practices and Assignment of Benefit
• Release of Health Records Request
• Record Amendment Request Form
• DOT Medical Examination Forms:
  • DOT Medical Cover Letter and Directions
  • DOT Medical Examination Form

• Sliding Fee Program Instructions and Application
• Sliding Fee Program Instructions and Application (Spanish)
• Financial Services Patient Pamphlet

If you wish to request a Release of personal medical records, please complete this form and return per instructions.

Release of Protected Health Information

• About Your Health Network
• Find A Health Center
• Patient Portal
• Pediatric and Adolescent Health
• Financial Services
• Palliative Care
• Inpatient Palliative Care
• Homeward Bound
• Family Planning Benefit Program
• Food, Financial and Transportation Resources

• Your Guide To A Healthy Pregnancy
• Domestic Violence Victim’s Rights Notice
• Domestic Violence Resources

Screening means checking your body for cancer before you have symptoms. Getting screening tests regularly may find breast, cervical, and colorectal (colon) cancers early, when treatment is likely to work best. Lung cancer screening is recommended for some people who are at high risk.

Cervical Cancer Screening – Patient Information

Cervical Cancer Facts – Patient Information

CDC Guidance
Monkeypox: Get the Facts
Monkeypox in the United States: What You Need to Know 

• Clinical Resources

• Preceptor Directory – LIC at Hudson Headwaters
• Student Affairs Team Chart – Who’s Who – UVM/Larner College
• Student Handbook-Larner College of Medicine
• Preceptor Forms:
  • LIC Monthly Formative Feedback
  • LIC Quarterly Feedback- Inpatient
  • Brief Structured Clinical Observation

Photo/Interview Consent Form