Records Release:

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 at 1130 South Elmwood, Mexico, MO 65265.  You
can also email the completed form to estotler@audraincountyhealth.org

Complete an Authorization Form
Audrain County Health Department
Public Health: Better Health, Better Missouri.