Skip to main content

COVID-19 Updates: Get the latest public information related to coronavirus disease 2019 (COVID-19) at ReadySLO.org.

The Health Agency is actively responding to COVID-19 and continuing to provide other essential services. Please see updates from Animal Services, Behavioral Health, Public Guardian and Public Health

Return to the top of the page

Forms & Documents > Public Health HIPAA Authorizations and Other Related Forms

Name Description Type
fentynal_lethal_dose_drugabuse.gov File
Form 815 - Universal Authorization to Share Information Form 815 - Universal Authorization to Share Information Link
HIPAA-Incident-Report_Public-Health HIPAA Incident Report Form - Public Health File
CCS-MISP-ROI - FILLABLE Authorization to disclose PHI from the CCS Program or MISP Program. (ROI Public Health HIPAA) File
ROI-For-information-FROM-another-entity-PASO-PH Authorization to request information from another entity - Paso Clinic. (ROI Public Health HIPAA) File
GENERIC-ROI-Can-be-used-for-any-purpose-in-any-division (Request Health Records) Generic Authorization to Share Information or Request Health Records. (ROI Public Health HIPAA) File