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Consumer Rights and Authorization for Release Forms

Consumer Rights Office

ATCIC’s Ombudsman is available for receiving and investigating allegations or rights violations regarding the investigation of allegations of abuse, neglect and exploitation (except substance use and specialized services, which are administered by the Department of State Health Services). Click here for more information.



Authorization for Release Forms

Authorization for Release of Protected Health Information PDF Document

Click the link above to download a form to request medical record information be released to a designated agency or individual.

Authorization for Release of Protected Health Information - SPANISH PDF Document

Click the link above to download a form to request medical record information to be released to a designated agency or individual.