HIPAA entitles every person the right to access his or her medical records, receive copies of them, and request
amendments to them. To ensure information is released according to the owner’s wishes, facilities are required
to verify the identity of the requestor and confirm that he or she is authorized to access or transfer the records.
If you are having the records sent to another person, you will need to provide their name and contact information.
The first step will be completing an “authorization for disclosure of protected health information” form. You can
print this form and bring it to our office, or mail it to ACHD P.O. Box 957, Mexico, MO 65265. You can also
email the completed form to firstname.lastname@example.org.
Complete an Authorization Form
|Audrain County Health Department
Public Health: Better Health, Better Missouri.