Medical Information Releasezach.fogleman2020-01-07T13:18:47-07:00
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:
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.
Help is a Call Away
Our Admissions Specialists are available 24 hours a day, seven days a week to provide no-cost mental health assessments. Call us at 702-322-1919 or visit our facility to get started. You can also use our online contact form for program inquiries. In the case of a medical emergency or crisis, please dial 911 or go to the nearest emergency room.