Authorization to Release Protected Health Information (PHI)

Hi-Desert Family Health Clinics undertake a legal and ethical responsibility to foster and preserve the privacy and confidentiality of customer information in all stages of development and use. Prior consent of the patient is required before any information is released, disclosed or made available for review.

As a patient, you may access some of your hospital medical record (including imaging and diagnostic information). Your Health Partner Portal provides electronic access. For more information about Your Health Partner Portal, CLICK HERE!

If you would like for our offices to send a copy of your medical records to another facility, please click HERE to download and print the form.  Please note that you will need to return this form to our clinic in person with an original signature in order for the request to be processed.  Faxed, mailed, or emailed copies will only be accepted with a copy of a Government issued identification attached (such as a driver’s license or passport).

If you would like your medical records sent to us from your previous doctor or medical facility, please click HERE to download and print the form. 

Please note that you will need to return this form to our clinic in person with an original signature in order for the request to be processed.  Faxed, mailed, or emailed copies will only be accepted with a copy of a Government issued identification attached (such as a driver’s license or passport).

The health information technician will process all requests timely and in the order in which they were received.  Please allow 7-10 days from receipt of the written request for processing time. Personal health information is not released by telephone.