Patient Forms

CMHC is committed to respecting and protecting your privacy.    We are legally required to protect your health information.  HIPAA is the Health Insurance Portability and Accountability Act, a Federal law that requires health providers to take steps to protect the privacy and security of patient health information.  CMHC is committed to respecting and protecting your privacy.    We are legally required to protect your health information.  HIPAA is the Health Insurance Portability and Accountability Act, a Federal law that requires health providers to take steps to protect the privacy and security of patient health information.  

The HIPAA Notice of Privacy Practices (HIPAA Notice of Privacy Practices) describes how CMHC uses and protects your health information.

If you would like to have your record released to anyone outside of CMHC, we require your consent.  Please complete the Authorization to Release Information.  If you have any questions, please contact us at 812-537-1302 and ask for the Medical Records Department. 

You can mail this completed form to:   

CMHC
Attn:  Medical Records
285 Bielby Road 
Lawrenceburg, IN  47025