Administrative Office727-824-8181 1344 22nd St South, St. Petersburg, FL 33712>Directions
This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).In addition, if the health center is asked who your insurance carrier is for purposes of filing medical malpractice claims, you should respond in writing whenever possible -- by stating that they and many/all of their providers are deemed federal employees, with resultant coverage under the Federal Tort Claims Act (FTCA) for actions within the scope of deemed employment, pursuant to 42 U.S.C. 233(g)-(n). Accordingly, claims or notice of medical malpractice claims should be submitted by a claimant to the Office of General Counsel at the address below. Further, the health center should retain a copy of this correspondence in their office files, rather than in patient medical records.U.S. Department of Health and Human ServicesOffice of the General CounselGeneral Law Division330 Independence Ave., S.W.Room 4760 Mail Stop: Capitol PlaceWashington, DC 20201
Community Health Centers of Pinellas's mission is to provide quality healthcare services to all.
Registration FormBill of Rights, Privacy, Advanced DirectiveConsent for Treatment FormPrivacy NoticePatient Medical HistoryInsurance VerificationConsent for Use and Disclosure of PHIBill of Rights, Responsibilities and Information
Welcome letter GYNPatient Medical HistoryConsent for Treatment FormPrivacy NoticeRegistration Form - EnglishPatient Medical HistoryInsurance VerificationConsent for Use and Disclosure of PHI
Forms for Adult, OB/GYN & Pediatrics are available for download/printing below. They are available in (PDF VERSIONS).
Bill of Rights, Responsibilities and InformationPatient Registration FormConsent for Use and Disclosure of PHIBill of Rights, Privacy, Advanced DirectiveConsent for Treatment of Adult or MinorPrivacy NoticePediatric History-pt Questionaire
Welcome Letter OBBill of Rights, Responsibilities and InformationAdult Medical HistoryCNM Disclosure LetterNotice to the Obstetric PatientPatient Registration FormConsent for Use and Disclosure of PHIBill of Rights Privacy - Advanced DirectivesConsent for Treatment of Adult or MinorPrivacy Notice