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CMS Addendum E Inpatient Only List

Anesthesia Forms

Heart & Vascular

Labor & Delivery

  • Anesthesia for Labor and C-Section  English  |  Spanish
  • Women's Pavilion & Birthplace Pre-Registration Form  English  |  Spanish

Surgery and Special Procedures

Authorization to Release Medical Information Forms

  • Authorization to Release Medical Information  English  |  Spanish

Note: The form can faxed to 919-350-7985 or mailed to: Medical Record Services - ROI, 3000 New Bern Avenue, Raleigh NC 27610

Imaging Services




Mail Order Forms

These forms are printed by WakeMed and can be ordered online and mailed to your practice in bulk at no charge.

Physician Office Orders