The Alaska Release of Medical Information, SHC-1012, is a form that patients can use to authorize a health care provider or other organization to release their medical records, such as test results, diagnoses, treatments, and other medical information. This form is used to protect patient privacy and ensure that medical records are not released to unauthorized individuals. There are two types of Alaska Release of Medical Information, SHC-1012: the standard form and the HIPAA-compliant form. The standard form is used for non-HIPAA compliant organizations and allows the patient to specify what information can be released and to whom it can be released. The HIPAA-compliant form is used for organizations that are subject to HIPAA rules and regulations and requires additional information such as the patient's Social Security number. Both forms must be completed and signed by the patient in order for the release of medical information to be valid.
Alaska Release of Medical Information, SHC-1012
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Release of Medical Information, SHC-1012
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Providing individuals with easy access to their health information empowers them to be more in control of decisions regarding their health and well-being. To request a copy of your medical records, call Cook Children's Release of Information Department in the main medical center building at 682-885-1012.For questions, call: 623-238-7470 (choose option 4). Complete this form to release your psychiatric information from the Student Health Center to the Academic Support and Access Center. ADHD Medication Agreement Group NumberReporting DateReporting Time1000Wednesday, May 31, 202 AM1001Wednesday, May 31, 202 AM1002Wednesday, May 31, 202 AM