Right to an Accounting of Disclosures

With certain exceptions, you have the right to an accounting of disclosures that we made of your health care information. Your request must be in writing and state a time period, which may not be longer than six years.

To submit a request, either send us a letter as outlined in our Notice of Privacy Practices or download the form below:

• Request for Accounting of Disclosures of Protected Health Information
• Request for Accounting of Disclosures of Protected Health Information (Spanish)