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URMC / Health Information Management / Release of Information (ROI) Forms
 

Release of Information (ROI) Forms

Complete this form if the executor/administrator of the estate has not yet been chosen

Complete this form to request records for Strong Memorial Hospital

Complete this form to request records for Highland Hospital

Complete this form to request an amendment of your protected health information for Strong Memorial Hospital

Complete this form to request your own records for Strong Memorial Hospital

Office for Civil Rights form should be completed when requesting information regarding HIV/AIDS

Complete this form to request an amendment of your protected health information for Highland Hospital

Complete this form to request your own records for Highland Hospital