Community Staff Resources

If you are one of our community partners, here you will find links to access forms, assistance with registering for the Bluestone Bridge and more information about Bluestone Community Education.

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Forms

• Community Staff Bridge Registration Form
• Provider Rounding Form (PDF)
• BPS Visit Prep Form (PDF)
• POLST (PDF)
• Service Vendor Validation Form
• Influenza Consent Form
• Bridge Nursing Guide
• CVS Flu Clinic Consent 

Spanish Forms

• Patient Enrollment Form – Spanish
• Patient Health History Form – Spanish
• PCMH Info Sheet – Spanish
• HIPAA Notice of Privacy Practices – Spanish
• Enrollment Checklist – Spanish
• Authorization Release – Spanish
• Consent HIPAA Acknowledgement – Spanish