Patient Information

Communication Consent

Reason for Visit

Labwork/Appointment

Confirmation

Labwork Requested!

We’re reviewing your labwork request. You’ll receive a call or text message from CHI Health Center shortly to confirm your labs have been sent to your chosen location. To change or cancel your labwork at any point, please contact CHI Health Center at 718-210-3110.

PATIENT NAME:

{Existing_Patient_Name (First):26.3} {Existing_Patient_Name (Last):26.6}

REASON FOR VISIT:

PrEP for HIV Prevention

LOCATION:

{CHI_1:46}{QUEST_1:49}{HOME_1:50}
{CHI_2:48}
{CHI_3:47}