HIPPA

HIPAA (The Health Insurance Portability and Accountability Act) Documents

• Notice of Privacy Practice - (spanish)
• Summary of Notice - (spanish)
• Authorization for Release of Protected Health Information Form
  Capital Region Medical Center recognizes the rights of our patients to release their health information.

  To facilitate a request for copies of medical records to be released, we ask that you:

1. Print the above‘AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION’ form.
2. Fill in all the required information on the form.
3. Sign and date the Authorization (must be signed by the patient, unless the patient is a minor or the patient has a legal representative assigned).
4. Include your phone number on the Authorization form in case we need to contact you.
5. Return the form by US mail to Capital Region Medical Center, Medical Record Department, P.O. Box 1128, Jefferson City, MO 65102-1128.
6. Payment of a fee may be required in some circumstances before the information can be released.

   If you have any questions about this process, please contact our Release of Information specialists at 573-632-5650.