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Available Forms

Medication Refill Request Form
Please make sure we have your current correct address

Refills can be picked up Monday & Wednesday from 10am to 4pm; Thursday 5pm to 7:30pm

SRCC, P.O. BOX 6, Lewiston, ID 83501

Medications not listed will not be filled

WAIVER- YOUR MEDICATION WILL NOT BE FILLED UNLESS THIS IS SIGNED

Immunity from Liability for Health Care Providers Providing Charitable Medical Care - Idaho Code: 39-7703. The above law says that our free clinic's health care providers, who voluntarily and without pay or expectation of being paid, provide you with medical or health care services at our clinic because you cannot afford to pay, are protected from being sued for any civil court action that comes about from them and our clinic providing you with needed medical or health services. This law for any intentional, willful, or grossly negligent acts does not protect us or if one of us provides a medical service outside of our licensed, certified, or registered scope of practice.

Please read the above waiver and acknowledge by typing your name here
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