Capital Physicians Group, P. A.

(919) 787-0486 - (919) 787-9931 Fax


Capital Physicians Group, P.A. Forms

Click on form needed to download forms and print out. Complete in full and bring into the office to update your files and prepare for your appointments.

Patients Form

Blood Sugar Log

Epworth Sleep Scale

Headache Dairy Instructions

 
Administrative Form

Patient Information Form

Review of System

HIPPA Release Form/ Consent of Treatment

 
Clinical Form

Medical Skill Inventory

Nursing Skill Inventory
 
Legal Forms

 

 

 

Medical Records


Obtaining Copies of Medical Records:
 
To protect the privacy and confidentiality of our patientís personal medical information, completion of a medical record release form is require when records are sent to a third party, such as another physician or health care provider, and attorney or insurance company.
 

Release forms may be picked up from our office or downloaded here. Please mail, fax or bring to the office. Records will not be sent until prepayment is received. Please allow 7-14 business days for the processing of these request.

 

Records are generally sent to other doctorís offices at no charge.

 

COPYING FEES

Pursuant to Section 90-411 of NCGS, the maximum fee charged for liability request are $.75 per page for the first 25 pages, $.50 per page for pages 26- 100, and $.25 per page for all pages over 100. We are allowed under this low to charge a minimum copying fee of $10.00. Other types request will be charge $1.00 per page.

-  3126 Blue Ridge Road, Raleigh, NC 27612 - (919) 787-0486 - Fax: (919) 787-9931 -