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Heartland Health
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Committed to meet the health care needs of the community

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HRMC HIPAA Authorization Form


Confidentiality and Privacy

Unless required by law, Heartland Health will not release personal health or identifying information to anyone – including a family member or employer – without the appropriate written consent from you.

If you would like to authorize the release of your protected health information, please complete the HIPAA Authorization Form.

Once you've completed this form, please return to Heartland Regional Medical Center.


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Heartland Regional Medical Center, 5325 Faraon St., St. Joseph, MO 64506, (816) 271-6000
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