Simplifying Medical Record Requests       

Protect Your Family's Medical Information Privacy

Downloadable Forms (PDF format)

Medical Record Request

Both consumer advocates and medical professionals recommend that individuals retain copies of their medical records. Use this form to obtain a copy of your medical records for personal use or to send to another provider.

Personal Disclosure Audit Letter

Find out to whom your doctor or any healthcare provider has released your health information. You are entitled to this information and consumer advocates recommend collecting this information once a year. This form formally requests a healthcare provider or facility to provide you a list of people or organizations that have received your records.

Health Privacy and Consent Notice

Take control of your protected health information and privacy. You have the right to opt out of marketing databases, research studies and restrict the disclosure of your health information. This form notifies healthcare providers and facilities of your preferences.