To download a form, Click on the applicable link below.
- Authorization for Disclosure of Health Information
- Authorization for Disclosure of Health Information (Spanish)
- Authorization to Receive Health Information
- Authorization to Receive Health Information (Spanish)
- Authorization for Duplication of Digital Images
- Authorization for Duplication of Digital Images (Spanish)
- Authorization for Release of Health Information (including alcohol-drug treatment and mental health information) and confidential HIV-AIDS Information (a NYS DOH required release form)
- Authorization for Release of Health Information (including alcohol-drug treatment and mental health information) and confidential HIV-AIDS Information (a NYS DOH required release form) (Spanish)
- Patient Request to Amend their Health Information
- Patient Request for an Accounting of Disclosures
- Patient Request to Restrict their Health Information
- Patient Request to Discuss Their Patient Health Information w/ a Designee
- Distributee Statement
