Mason-Dixon Mobile Medicine
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General Information
Notice of Privacy Practices
Maryland MOLST Form
01/26/2025 Patient Letter
​*New Patient Intake Form
*G​lobal Consent Form
​*Authorization to Release Health Information
​*Care Management Consent
*Must be returned to office prior to first visit.
Click here to complete documents electronically using our HIPAA-compliant signature platform (BoldSign).
If you are signing forms as health care agent (aka, medical power of attorney), we will need a copy of the POA documents and a way to validate your identification. Thank you for your cooperation.
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CONTACT US TODAY!

240-397-6723
Email for more info!

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