Notice of Privacy Practices
Bill of Patient Rights
Collecting New Patient Demographic Info.
Request to Amend Protected Health Info.
Release of Patient Information
IMPORTANT INFO for RELEASE OF INFORMATION
- Photo ID must be attached to the form (patient and person picking up the records)
- Form must be completed entirely and signed (physical signature)
- HIM staff has 15 business days to complete a request
- HIM business hours are Monday-Friday 8 am – 4 pm