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Certificates & Health Records
Records release form

The law protects the privacy of the health information you give us when we provide care and services to you. For example, your medical record may include your symptoms, test results, conditions, treatment and insurance information.

Federal and state law allows us to use and share your health information for treatment and health care reasons without your approval. State law requires us to get your approval to give this information to your insurance company so they can pay your bill. We will not give out your health information to others unless you tell us to do so, or unless required by law. For more information, view our Notice of Privacy Practices.

How do I authorize my medical records to be released?

  1. Print the authorization form (PDF).
  2. Complete and sign the form.
  3. Return the form to Clark County Public Health:
  • FAX - (360) 397-8402
  • Mail - Clark County Public Health, PO Box 9825, Vancouver, WA 98666
  • In person - Center for Community Health, 1601 E Fourth Plain Blvd., third floor, Vancouver.

How much does it cost?
There may be a fee for making copies of your record. Please contact Medical Records for more information at (360) 397-8000 ext. 3084.

For more information or to report a problem with your health information, contact:
Clark County Privacy Officer
PO Box 5000
Vancouver, WA 98666

 

Related information
  • Notice of privacy practices - Explains how we may use and share your health information.
  • The Privacy Rule - National standards to protect individuals’ medical records and other personal health information. (US Department of Health and Human Services)
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Spanish contact information

(360) 397-8000 ext. 7205

Russian contact information

(360) 397-8000 ext. 7214