It is the policy of Gastroenterology & Hepatology Institute of Nevada to treat all patients and not to discriminate on the basis of race, color, religion, national origin, age, sex, sexual orientation, gender identity or expression, disability, veteran status, or any other basis prohibited by federal, state, or local law
AUTHORIZATION FOR ACCESS TO MEDICAL RECORDS:
We require a written authorization form, duly signed by the patient, for the release of medical records (Protected Health Information) to anyone – physicians, family members, caretakers etc. A valid ID is required for anyone who comes to pick-up records from our office.
Below, please list the individuals that you would like to have access to your health information. You can include family members and any physicians who are involved in your care. This serves as a written consent to release records to those listed below. You may revoke the right you have given the individuals listed below AT ANY TIME.
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: POLICIES
Agree & Sign