Skip to content
  • Client Login
  • Forms
eHealth Technologies Logo
  • Record Retrieval
    • How it Works
    • Customer Solutions
    • Implementation
    • Customer Stories
    • Customer Resources
  • Image Exchange
    • How It Works
    • Customer Solutions
    • Customer Stories
    • Customer Resources
  • News & Events
    • News
    • Events
    • Blog
  • About Us
    • History
    • Executive Team and Board
    • Partnerships
    • Compliance and Patient Privacy
  • Contact
  • Patient Tools
  • Careers
Authorization Forms LibraryeHealth Contributor2022-12-13T11:21:39-05:00

Authorization Forms Library

To expedite the process, please make sure you:

1) PRINT the full name of the person seeking care

2) SIGN and DATE the form

3) FAX or MAIL the form to: 866-920-5565 or eHealth Technologies, 250 Thruway Park Drive, West Henrietta, NY 14586

Authorization Forms links:

  • Columbia University Medical Center: Authorization to Release Medical Information
  • Hinge Health: Authorization to Release Medical Information
  • Mayo Clinic: Authorization to Release Protected Health Information
  • Mindstrong Health: Gabe Aranovich, MD
  • Mount Sinai Medical Center: Patient Authorization for Release of Medical Information
  • New York City Health and Hospitals Corporation (NYCHHC): HIPAA Authorization to Disclose Health Information
  • NewYork-Presbyterian Hospital: Authorization Form to Disclose Protected Health Information/Medical Records (English)
  • NYU Langone Medical Center: Authorization for Release of Protected Health Information (PHI)
  • Oschner Medical Center: Authorization for Release of Confidential Information (English) and Authorization for Release of Confidential Information (Spanish)
  • Thomas Jefferson University: Consent to Release Medical Information
  • UPMC: Patient Authorization
  • Westchester Medical Center: Authorization to Use or Disclose Protected Health Information
eHealth Logo

eHealth Technologies, Inc. | 250 Thruway Park Drive | West Henrietta, NY 14586 | P 877-344-8999
Employee Website | Employee Email

  • Record Retrieval
  • Image Exchange
  • News & Events
  • About Us
  • Contact
  • Careers
  • Client Login
© eHealth Technologies All Rights Reserved Privacy Policy Internet Privacy Policy Cookie Policy
Page load link
Go to Top