Release of Information - Records Request

To request access to your records (immunizations, communicable disease records, WIC, etc.), complete the Release of Information Form using the link below. Forms must be completed by individuals age 18 or older. If you are requesting records for multiple minors, a separate form is required for each child.

Federal law says that we cannot share your health information without your permission, except in certain situations. If you sign this form, you are giving us permission to share the health information you indicate below. This does not prevent the information from being re-shared by the recipients. 

Please complete the following information for the request of release of records from Lewis and Clark Public Health (LCPH). Please allow 4 business days for the request to be processed. 

If you need help with this form, please call 406-457-8900.

RELEASE OF INFORMATION FORM: 

https://form.jotform.com/LC_PH/LCPH-authorization-ROI