• This tool is for patient use ONLY
• Watch a short video tutorial that walks you through this tool
• This should take under 5 minutes to complete
• IMPORTANT – please do not click the back button in your browser, as this will erase your information

Begin Records Request

• This tool is for healthcare providers ONLY
• When prompted, please use your organizational (HIPAA-compliant) email address
• This should take under 5 minutes to complete
• IMPORTANT – please do not click the back button in your browser, as this will erase your information

Begin Records Request

• Privacy Complaint
• Request for Accounting of Disclosures
• Request for Amendment/Correction of Health Information
• Request for Confidential Communications
• Request for Restriction of Use and Disclosure

• Queja de privacidad
• Solicitud de historial de divulgaciones
• Solicitud de modificación/corrección de información medica
• Solicitud de comunicaciones confidenciales
• Solicitud de restricción de uso y divulgación