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Patient Policies & Forms

Thank you for making SEARHC your health care provider of choice. We appreciate the trust you place in us to take care of you and your loved ones. Our high-quality care extends beyond clinical care to our business services as well. Please find more information about specific patient policies below:

Health Records Request

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If you need a copy of your Health Records or Health Information for pick-up, or to be faxed to a provider, simply download, print, fill-out, and return one of the following forms to us.

Please include a copy of your valid identification when submitting any requests, or you may show your identification upon picking up your medical records. Please note that you will need to include a form of ID if you do email or fax your request.

Mailing address:
HIM Department
3100 Channel Drive, Ste 300
Juneau, AK 99801
Phone: 907.463.6630
Fax: 907.463.4012
Email: release@searhc.org

  1. If you are requesting your own records or are the legal personal representative (e.g. guardian) of the individual and want copies for yourself or to have the records sent to someone, please use this form: Patient Request for Access to Personal Health Information.
  2. If you are a third-party (e.g. lawyer, school, insurance company, employer) and want records of another individual, please use this form: Authorization to Disclose Protected Health Information. We may contact the individual to confirm this request.
  3. If you are requesting Behavioral Health records, please complete the following ROI: Authorization to Disclose BH Protected Health Information.

To electronically sign one of these forms

  • Download the form.
  • Open it in Adobe Acrobat Reader.
  • Type your information into the form.
  • Then select “Fill & Sign” to use the pen tool for your signature, or initials as requested.

Health Information Forms

Telehealth Information

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Telemedicine Consent Form –Please review the following form. You may be requested to bring a signed copy before your first appointment.


When completed, the following forms contain confidential information. We ask that, at this time, you do not email these forms to SEARHC. Also, we recommend patients avoid using public computers when providing personal health information.

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Authorization for Treatment and Promise to Pay with Telehealth Consent (fillable form)

Notice of Privacy Practices Acknowledgement (fillable form)

Patient Information Form (fillable form)