Click here for Authorization for Release of Medical/Dental Records Form in English: English Version of Request Form
Click here for Authorization for Release of Medical/Dental Records Form in Spanish: Spanish Version of Request Form
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Keystone Health Center is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. In addition, Keystone Rural Health Center receives HHS funding and has Federal PHS deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.