Here are forms that pertain to your care. Please note that the forms are in Adobe PDF format, and you will need to have the free Adobe Acrobat Reader software installed on your computer. You can download the software here.
Release Forms
Request Forms
- Amendment of PHI Request Form
- Accounting of Disclosures Request Form
- Request for Alternative Communications
- Request to Restrict Uses and Disclosures of Protected Health Information to Hea…
- Westmed Family Access Form (Patient Portal Caregiver Access Authorization Form)…
- Westmed Family Access Form (Patient Portal Caregiver Access Authorization Form)…
- Request to Restrict Uses and Disclosures of PHI
Healthcare Proxy/Advanced Directive
Please note that we may disclose your medical information to contractors, agents and other business associates who need the information in order to assist us in obtaining payment or carrying out our business operations. For example, we may share your medical information with a billing company that helps us to obtain payment from your insurance company. Another example is that we may share your medical information with an accounting firm, law firm or risk management organization that provides professional advice to us about how to improve our health care services and comply with the law. If we do disclose your medical information to a business associate, we will have a written contract to ensure that the business associate also protects the privacy of your medical information.