Teen Health Center document downloads

• Consent to Bill and Treat, Acknowledgement of Receipt with translated Notice of Privacy Practices:
  • English consent
    • Notice of Privacy Practices
    • Notice of Privacy Practices brochure (available in English only)
      
      
  • Russian consent
    • Notice of Privacy Practices
      
      
  • Spanish consent
    • Notice of Privacy Practices
      
      
  • Vietnamese consent
    • Notice of Privacy Practices
      
      
• Letter to parents informing them about services available to students at the Cleveland Teen Health Center:
  • Microsoft Word (English)
  • Microsoft Word (Spanish)
  • Adobe PDF (English)
  • Program Description/Disclosure, Participant Rights and Consent to Participate, Kaiser Permanente (MS Word)
    
    
• Client Registration Worksheet
  • Spanish (MS Word)
  • Russian (MS Word)
  • Vietnamese (MS Word)
    
    
• Consent to Release of Education Records Under the Family Education Rights and Privacy Act (FERPA), (PDF)
  • Chinese, Traditional
  • Oromo
  • Spanish
  • Tigrinya
  • Vietnamese

COVID-19 resources

King County:

• Schools and Child Care COVID-19 webpage

Washington State:

• Coronavirus - COVID-19 Updates, WA State Dept. of Children, Youth, and Families
• Novel Coronavirus (COVID-19) Guidance & Resources, WA Office of Superintendent of Public Instruction (OSPI)

• Consent to Bill and Treat, Acknowledgement of Receipt with translated Notice of Privacy Practices:
• English consent
  • Notice of Privacy Practices
  • Notice of Privacy Practices brochure (available in English only)
• Russian consent
  • Notice of Privacy Practices
• Spanish consent
  • Notice of Privacy Practices
• Vietnamese consent
  • Notice of Privacy Practices
• Letter to parents informing them about services available to students at the Ingraham Teen Health Center:
  • English letter (MS Word)
  • Spanish letter (MS Word)
  • Program Description/Disclosure, Participant Rights and Consent to Participate, Kaiser Permanente (MS Word)
    
    
• Ingraham Teen Health Center patient registration form (English, PDF)
• Ingraham Teen Health Center patient registration form (Spanish, PDF)
  
  
• Consent to Release of Education Records Under the Family Education Rights and Privacy Act (FERPA), (PDF)
  • Amharic
  • Chinese, Simplified
  • Chinese, Traditional
  • Oromo
  • Somali
  • Spanish
  • Tigrinya
  • Vietnamese

COVID-19 resources

King County:

• Schools and Child Care COVID-19 webpage

Washington State:

• Coronavirus - COVID-19 Updates, WA State Dept. of Children, Youth, and Families
• Novel Coronavirus (COVID-19) Guidance & Resources, WA Office of Superintendent of Public Instruction (OSPI)

Letter to parents informing them about services available to students at the Rainier Beach Teen Health Center:

• Microsoft Word (English)
• Microsoft Word (Spanish)
• Adobe PDF
• Program Description/Disclosure, Participant Rights and Consent to Participate, Kaiser Permanente

Consent to Bill and Treat, Acknowledgement of Receipt with translated Notice of Privacy Practices:

• English consent
  • Notice of Privacy Practices
  • Notice of Privacy Practices - Brochure
    
    
• Russian consent
  • Notice of Privacy Practices
    
    
• Spanish consent
  • Notice of Privacy Practices
    
    
• Vietnamese consent
  • Notice of Privacy Practices

Client Registration

• Client Registration Worksheet
  • Client Registration Worksheet, Russian
  • Client Registration Worksheet, Spanish
  • Client Registration Worksheet, Spanish
  Client Registration Worksheet, Vietnamese

Consent to Release of Education Records Under the Family Education Rights and Privacy Act (FERPA)

• FERPA, English
• FERPA, Chinese
• FERPA, Spanish

COVID-19 resources

King County:

• Schools and Child Care COVID-19 webpage

Washington State:

• Coronavirus - COVID-19 Updates, WA State Dept. of Children, Youth, and Families
• Novel Coronavirus (COVID-19) Guidance & Resources, WA Office of Superintendent of Public Instruction (OSPI)