Authorization to Disclose Information

Spring Mountain requires that all patients complete an Authorization to Disclose Form to release any protected health information. Please submit the original form and a copy of your photo ID to our Health Information Management department in-person, via fax, or mail to the corresponding facility.

Download the forms for each facility below:

Spring Mountain Treatment Center
7000 Spring Mountain Road
Las Vegas, NV 89117

Fax: 702-873-1859

Spring Mountain Sahara
5460 West Sahara Ave.
Las Vegas, NV 89146

Fax: 702-216-8960

Please Note the Following Guidelines:

  • An original authorization form is required for each release, meaning that multiple parties cannot be listed on the same authorization.
  • The specific information to be released must be noted and all sections must be completed on the Authorization to Disclose form in order to process your request.
  • The authorization form must be signed by the patient (ages 18 and older) or by the parent or guardian for all minors (17 and younger).
  • The legal guardian in cases of adjudicated incompetence must sign the authorization. Proof of guardianship must be provided. When applicable, the request must be accompanied by proof of the Durable Power of Attorney. In the case of a deceased patient, a copy of the death certificate and proof of status as the administrator of the estate must be provided.
  • According to the Nevada Revised Status (629.061), medical records printed or photocopied for reasons other than continuity of care are subject to a copy fee of $.60 per page.

If you have any questions, contact the Health Information Management Department at 702-873-2400.

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