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Public Records Request Form


If any records requested contain Protected health Informaiotn (PHI) about a person who is not you, this request must be accompanied by an Authorization to Release medical Information under the Health Insurance Portability and Accountability Act of 1996 (HIPPA)

*Records sent by email or fax transmission will be sent through UNENCRYPTED FAX/EMAIL THAT IS NOT SECURE and there is a risk that the records could be seen by a thrid party during electronic transmission, while in electronic storage, and/or upon completed delivery. The District is not responsible for unathorized access of Protected Health Information (PHI resulting from the faxed or emailed transmission, or for safeguarding PHI upon delivery.
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