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Services
Internal Medicine
Primary Care
Preventative Care
Providers
Christopher Brana, MD
Michelle Fishman, PA-C
Tessa Shuler, FNP-C
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Services
Internal Medicine
Primary Care
Preventative Care
Providers
Christopher Brana, MD
Michelle Fishman, PA-C
Tessa Shuler, FNP-C
About Us
Our Team
Resources
Patient Forms
Policies Fees And Insurance
Make a Payment
Blog
Accessibility Statement
Contact
Services
Internal Medicine
Primary Care
Preventative Care
Providers
Christopher Brana, MD
Michelle Fishman, PA-C
Tessa Shuler, FNP-C
About Us
Our Team
Resources
Patient Forms
Policies Fees And Insurance
Make a Payment
Blog
Accessibility Statement
Contact
Services
Internal Medicine
Primary Care
Preventative Care
Providers
Christopher Brana, MD
Michelle Fishman, PA-C
Tessa Shuler, FNP-C
About Us
Our Team
Resources
Patient Forms
Policies Fees And Insurance
Make a Payment
Blog
Accessibility Statement
Contact
Appointment
Services
Internal Medicine
Primary Care
Preventative Care
Providers
Christopher Brana, MD
Michelle Fishman, PA-C
Tessa Shuler, FNP-C
About Us
Our Team
Resources
Patient Forms
Policies Fees And Insurance
Make a Payment
Blog
Accessibility Statement
Contact
Services
Internal Medicine
Primary Care
Preventative Care
Providers
Christopher Brana, MD
Michelle Fishman, PA-C
Tessa Shuler, FNP-C
About Us
Our Team
Resources
Patient Forms
Policies Fees And Insurance
Make a Payment
Blog
Accessibility Statement
Contact
Appointment
Medication Consent Form
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Prescription Medication Consent Form
The providers at California Coast Physicians, used an electronic medical record system that allows electronic prescribing of medications. Medications are sent to your pharmacy through a secured electronic prescription connection (Dr. First) which improves the timely and accurate transmission of your medication information. To optimize the use of this electronic capability, and coordinate your care between us and your specialist, we ask that patients allow us to access their medication history through Dr. First.
Please check only one of the following:
(Required)
I consent to allow my provider to access all of my medication history.
I consent to allow my provider to access only my medication history for medications prescribed in this office.
I DO NOT consent to my provider accessing any of my medications.
Printed Name
(Required)
First
Last
Date
(Required)
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