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98-1079 Moanalua Road, Suite 500 & 555

Aiea, HI 96701

Adult: 808-488-0990

Pediatrics: 808-488-1943

Pearl City Medical Associates

Adult & Pediatric Medicine

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Forms

Adult Medicine

Patient Registration Form
Adult Medicine General Patient Form
Request for Access to Health Information
Authorization for Release of Health Information from PCMA
Authorization for Release of Health information to PCMA
MyChart Adult Proxy Access Request Form

Pediatric Medicine

Patient Registration Form
Child General Patient Form
Request for Access to Health Information
Authorization for Release of Health Information from PCMA
Authorization for Release of Health Information To PCMA
Authorization for Treatment of Unaccompanied Minor
Children w/ Special Health Care Needs Screener

Pearl City Medical Associates

98-1079 Moanalua Road, Suite 500 & 555, Aiea, HI 96701

Adult: 808-488-0990 | Pediatrics: 808-488-1943 | Business Office: 808-488-7999

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