Mosaic Life Care > Notice of Privacy Practices > HIPAA Authorization Form

HIPAA Authorization Form

Confidentiality and Privacy

Unless required by law, Mosaic Life Care will not release personal health or identifying information to anyone – including a family member or employer – without the appropriate written consent from you.

If you would like to authorize the release of your protected health information, please complete the HIPAA Authorization Form.

Once you've completed this form, please return to Mosaic Life Care at St. Joseph - Medical Center.