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Patient Forms

Below are links to frequently used patient forms. These forms must be downloaded and saved, if you do not see the form you need, or if you would like assistance filling out a form, please call 208-983-1700 and ask for medical records.

Click here if you need Syringa to send your medical record to another provider or to obtain a copy for personal use.
If requesting a copy for personal use, view price sheet by clicking here.

Click here when you need to have your record sent from another provider to Syringa.

Click here to complete form to change or update your Medical Records.

Click on form to download. Once downloaded and filled out, save to your device before printing and signing. Completed forms can be submitted by emailing to or sending to:

Syringa Hospital & Clinics
Medical Records Department
607 W. Main Street
Grangeville, ID 83530

Advance Directives

Click here to complete your Advance Directives, also known as a living will.

If you have questions or would like help filling out your Advance Directives form, please contact Amanda Holcomb, LMSW at the Primary Care Clinic 208-983-8590.

Medication Tracking

Click here to complete a patient medication list. Use it to keep track of your medications and feel free to bring it to your clinic appointments.