HIPAA Related Forms

Medical Record Request

To receive more detailed information on submitting a request for medical records, please click on the link below that best describes who you are

header-title-decorationHIPAA Related Forms

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that protects sensitive patient health information from being disclosed without the patient’s consent or knowledge.

Request for Authorization English | Spanish

Request for Access English | Spanish

Request for Restrictions

Request for Confidential Communications

Request for Amendment

To understand what type of form to use, click here