Make a Request - Medical BillingResolution for Establishing a Policy for Requests for Public RecordsHIPAA Authorization to Release Medical InformationYour Name (required)PhoneYour Email (required)Date Requested (mm/dd/yyyy) (required)I have read Resolution No. 2018-09 (linked above) (required)YesDetailed Description of Records RequestedPlease upload completed HIPAA Authorization to Release Medical Information (linked above)There was a problem saving your submission. Please try again later.Please wait while your submission is being saved...Submitting...SubmitThank you, your submission has been received.
