In some situations, you may want to review or need to authorize L.A. Care to release your Protected Health Information ("PHI"). In these situations you will need to fill out the form below.
- Request to Inspect, Copy, and Release PHI - English
- Request to Inspect, Copy, and Release PHI - Spanish
- Request to Inspect, Copy, and Release PHI - Chinese
- Request to Inspect, Copy, and Release PHI - Korean
- Request to Inspect, Copy, and Release PHI - Armenian
- Request to Inspect, Copy, and Release PHI - Russian
- Request to Inspect, Copy, and Release PHI - Tagalog
- Request to Inspect, Copy, and Release PHI - Vietnamese
- Request to Inspect, Copy, and Release PHI - Farsi
- Request to Inspect, Copy, and Release PHI - Khmer/Cambodian