How to Obtain Release of Information

SSMH takes pride in keeping your protected health information secure.

To receive copies of your SSMH health information, you must fill out a Release of Information (ROI) form and bring in a picture ID to the front desk at SSMH. At the Documents section on the right, you’ll find an ROI from SSMH and ANMC.

IF YOU WOULD LIKE YOUR SSMH HEALTH INFORMATION RELEASED TO YOURSELF OR ANOTHER FACILITY, PLEASE FOLLOW THESE STEPS:

IF YOU ARE OVER 18 OR AN EMANCIPATED MINOR:

Your picture ID is required to allow us to release your information securely.

IF YOU ARE THE PARENT OF A MINOR CHILD:

Your picture ID is required to allow us to release their information to you securely.

IF YOU ARE THE GUARDIAN OF A MINOR CHILD OR INCAPACITATED ADULT:

Your picture ID and proof of guardianship are required to allow us to release the information to you securely.

IF YOU WOULD LIKE YOUR HEALTH INFORMATION FROM ANOTHER FACILITY SENT TO SSMH, PLEASE FOLLOW THESE STEPS:

IF YOU ARE OVER 18 OR AN EMANCIPATED MINOR:

Your picture ID is required to allow that facility to release your information to SSMH securely.

IF YOU ARE THE PARENT OF A MINOR CHILD:

Your picture ID is required to allow that facility to release their information to SSMH securely.

IF YOU ARE THE GUARDIAN OF A MINOR CHILD OR INCAPACITATED ADULT:

Your picture ID and proof of guardianship are required to allow that facility to release their information to SSMH securely.

*** SSMH does not re-disclose any protected health information received by outside facilities. If you want your own records from another facility, you must contact that facility yourself.