Our Notice of Program Accessibility
addresses Samaritan Health Services commitment to accessibility and non-discrimination.
addresses Samaritan Health Services web presence and its use.
Our SHS Notice of Privacy Practices
describes how medical information about you may be used, disclosed, and how you can get access to this information.
Authorization to Request from Non-Samaritan Health Services Care Provider:
English | Spanish
Patient Request for Restriction of Uses and Disclosures: English | Espanol
Patient Request for Accounting and Disclosures: English | Espanol
Patient Request for Amendment of Medical Record: English | Espanol
Patient Request for Confidential Communications: English | Espanol
Patient Authorization to: Discuss Health Information (Verbal) with Friends and Family and/or Leave Care-Related Messages on a Messaging System: English