• SHALOM HEALTH CARE CENTER, INC.

    PROVIDING QUALITY HEALTH CARE THAT IS PATIENT-CENTERED, AFFORDABLE AND ACCESSIBLE FOR ALL IN OUR COMMUNITY.
  • PATIENT CONSENT FOR TREATMENT OF MINORS AND/OR RELEASE OF INFORMATION TO OTHERS

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  • to consent, in my absence, for all medical treatment and/or medical procedures. Shalom Health Care Center may rely upon this consent with the same force and effect as if personally executed by me.
  • All decisions indicated above will remain in effect until terminated by me in writing.
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  • 3400 Lafayette Road, Suite 200 • Indianapolis, IN 4622
    5750 West 56th St. Indianapolis, IN 46254

    PHONE: 317-291-7422 • CONFIDENTIAL MEDICAL FAX: 317-291-4912

     
  • 3400 Lafayette Road, Suite 200 • Indianapolis, IN 4622
    5750 West 56th St. Indianapolis, IN 46254
    PHONE: 317-291-7422 • CONFIDENTIAL MEDICAL FAX: 317-291-4912
  • The Center receives federal funding from Department of Health and Human Services (HHS) and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

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