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Release Authorization

Your personal health information rights

Notice of Privacy Practices effective April 14, 2003

US Department of Health and Human Services (http://www.hhs.gov/) Office for Civil Rights HIPAA fact sheet:

Health information (medical records) release form instructions

Medical Records Release Form

If you have questions, need more information, or want to report a problem with your health information, please contact:

Clark County Privacy Officer
P.O. Box 5000
Vancouver, WA 98666
E-mail: Hipaa@clark.wa.gov
Phone: (360) 397-6121 ext. 4139

Clark County Public Health: Director John Wiesman
Street Address: 1601 East Fourth Plain Boulevard, Vancouver, WA 98661
Mailing Address: P.O. Box 9825, Vancouver, WA 98666-8825
Main phone: (360) 397-8000
TTY: (360) 397-8407
E-mail: Public.Health@clark.wa.gov

Responsible Elected Official: Board of Clark County Commissioners

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