HIPAA Release of Protected Health Information

If you would like any of your or your child's information released to another individual please download and fill out the following form then return the completed form to CorCell. Your records will be sent out within 10 business days.

HIPAA Authorization to Release/Request for an Individual's Health Information

 

Under HIPAA guidelines we cannot discuss your information or your child's information with anyone unless we have your written conscent. If you would like to give us permission to discuss your information and your child's information with anyone please fill out the following form.

HIPAA Authorization for Verbal Release of Protected Health Information

REQUEST MORE INFORMATION

First Name

Last Name

Phone Number

Email Address

Due Date