Patient Documents

Welcome to the Acaria Health Family of Pharmacies

We're ready to help. Let's get started. 

This welcome kit guides you through the process of getting started with our pharmacy. If you have any questions along the way, we are happy to help you! You can reach us anytime.

Contact Us
document example: Welcome letter

Welcome Letter (English) 

Download (PDF)
document example: Patient bill of rights

Patient's Bill of Rights and Responsibilities (English)

Download (PDF)
document example: language assistance

Language Assistance/Nondiscrimination Notice (English)

Download (PDF)
document example: language assistance

Language Assistance

Download (PDF)
document example: FAQ

Frequently Asked Questions (English)

Download (PDF)
document example: Privacy Practices

Notice of Privacy Practices Acknowledgment of Reciept (English)

Download (PDF)
document example: Prescription coverage

Medicare Prescription Coverage and Your Rights (English)

Download (PDF)

Additional Patient Documents

Notice of Privacy Practices Booklet (English) (PDF)
Patient HIPAA Authorization Form (PDF)
Assignment Agreement (PDF)
Emergency Management Plan (PDF)
Proper Medication Disposal (PDF)
Safe SHARPS Disposal (PDF)
Complaint Form (PDF)

Guiding You Every Step of the Way

What happens next? Our team will:

  • Remind you when it’s time to schedule your refill by call, text or email.
  • Contact you to offer ongoing support and education, and discuss any changes in your therapy.
decorative