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Site Partner Information and Forms



Additional Related Information

Documents

Site Partner Brochure
File Size: 1118.06 kb

Information to promote the program in communities and schools.


Site Partner Information
File Size: 104.24 kb

A guide to organize a Ronald McDonald Care Mobile visit to your community.


Sample Site Partner Letter of Agreement
File Size: 20.89 kb

A letter of agreement between the site partner and Ronald McDonald House Charities outlining the roles and responsibilities of each party.


Site Partner HIPAA Agreement
File Size: 195.01 kb

This document outlines the site partner requirements in terms of the Health Insurance Portability and Accountability Act.


Site Partner Community Promotion Poster
File Size: 33.38 kb

A poster template to promote the program in the local community.


Parent Information Card
File Size: 134.22 kb

Information about the program and locations.


Program Eligibility Requirements
File Size: 33.62 kb

An information sheet outlining the program eligibility requirements to be seen.


Parent Information Sheet/Sign Up
File Size: 41.37 kb

An information sheet that promotes the program and provides a sign-up form for parents.


Medical/Dental Coverage Options
File Size: 85.89 kb

A sing-up form for parents to determine eligibility for dental program coverage.


Parent Enrollment Letter
File Size: 79.15 kb

Information about the program and the eligibility criteria.


Patient Rights and Responsibilities
File Size: 86.98 kb

Information for parents outlining patient rights and responsibilities.


Notice of Privacy Practices
File Size: 130.31 kb

Parent/patient notice of privacy practices.


Patient Information and Consent Forms
File Size: 120.41 kb

Forms to be completed and signed by parents/guardians, including the child's dental and medical history, insurance information and consent forms.


After the Ronald McDonald Care Mobile Visit
File Size: 165.25 kb

An information sheet on parent and community follow-up after the visit.