Medical Records

Attached below are the General and Behavioral Health (BH/DA) patient Authorization forms for the use and disclosure of Protected Health Information (PHI).

Click on the reports to open and print the forms.

Authorization for Warren General Hospital to use or disclose your protected health information to other entities

Authorization for other entities to disclose your protected health information to Warren General Hospital

Behavioral Health/Drug and Alcohol Authorization for other entities to disclose your protected health information to Warren General Hospital

Behavioral Health/Drug and Alcohol Authorization for Warren General Hospital to use or disclose your protected health information to other entities