Skip to main content

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. The privacy of your information is important to us.

Notice of Privacy Practices

Below is the authorization form for disclosure of protected health information (PHI).

Authorization form for Disclosure of Protected Health Information


We’re here to support you

866-333-3530 (TTY 711)
8:00 am to 8:00 pm PT, Monday through Friday