Medical Record Authorization Form

Sapphire Community Health is required by law to maintain the privacy of your health information, to provide you with a notice of our legal duties and privacy practices, and to follow the information practices that are described in our Notice of Privacy Practice.   
You have the right to receive a copy of your health information that we maintain, with some limited exceptions. You have the right to receive a copy of your health information in a format you prefer (e.g., paper, email, fax, MyChart).

To receive a copy of your health information, you may stop at the clinic to obtain a physical form, or download and complete our Release of Information.