Release of Information (R.O.I)
Alaska Island Community Services abides by all federal HIPAA and CFR 42 Part II regulations to safeguard and protect your health information. The Release of Information form is required for us to be able to provide any of your health information to a third party for any reason not permitted under federal regulations.
If you have any questions about our Privacy Policies, please read our Privacy Notice.
You may request to complete or update this form at any time. If you would like instruction on how to complete the form to best protect your information, you may contact the department you are receiving services from directly.
Click below to download
the Release of Information forms for Behavioral Health and Medical clinic: