| Description | Download |
|---|---|
| Authorization for release of medical records and information Signing this form allows Northside to share a patient's protected health information (PHI) with specified individuals or organizations, according to the details stipulated in the form by the patient. | English, Spanish, Korean |
| Request for correction/amendment of protected health information This form allows patients to request a change, edit, or update on their health information record maintained by Northside. | English, Spanish |
| Request for accounting of certain disclosures of protected health information This form allows patients to receive an accounting of disclosure of their health information that was made for purposes other than treatment, payment, or health care operations. | English, Spanish |
| Request for limitations and restrictions of protected health information This form is used to restrict the use and/or disclosure of patient’s health information by Northside. This form is not applicable during emergency treatments. | English |