Medicare Urgent Care Clinics Data Consent form

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Medicare Urgent Care Clinics Data Consent form

The Medicare Urgent Care Clinics (Medicare UCC) Data Consent form is available in English and 12 other languages including Arabic, Filipino, Greek, Hindi, Italian, Korean, Punjabi, Simplified and Traditional Chinese, Spanish, Thai and Vietnamese.

When visiting a Medicare UCC, you will be given this consent form asking for your consent to share your information with the Department. You do not need to bring this form with you when you visit a Medicare UCC. If you decide not to consent, you will still be treated at the Medicare UCC.

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