Release of Information
The Behavioral Health Wellness Clinic (BHWC) Release of Information form authorizes the BHWC to use and disclose your health information and substance use disorder treatment information with your treating health care providers.
The BHWC Release of Information form will only release information regarding your care at the ANTHC Behavioral Health Wellness Clinic.
You may complete the online Release of Information request or
Fill out the printable Release of Information form, then submit it to the BHWC by fax at 907-729-3950 or at our secure online portal.
Revoke or Cancel Prior Authorizations
If you authorized us to use or disclose your health information, you may revoke your authorization in writing at any time. Once revoked, we will no longer use or disclose your health information for the reasons covered by your initial written authorization.
You may only revoke an authorization you made for yourself or your minor child.
This revocation of the authorization will not affect any action we took in reliance on the initial authorization prior to receiving revocation notice.
Fill out the printable Revocation of Release of Information form, then submit it to the BHWC by fax 907-729-3950 or at our secure online portal.
ANMC Medical Record Request
To obtain your medical records from the Alaska Native Medical Center, please complete the ANMC Medical Record Request form.