Release of Information - Records Request

To request access to your records (immunizations, communicable disease records, WIC, etc.) please use the link provided below.

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 request to be processed. 

You will need to fill out a new request per facility or person.  

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

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