Patient Forms Page
Notice of Privacy Practices
Your health care provider and health plan must give you a notice that tells you how they may use and share your health information. It must also include your health privacy rights. In most cases, you should receive the notice on your first visit to a provider or in the mail from your health plan. You can also ask for a copy at any time or review using the link below.
Components of the Notice of Privacy Practices:
- Must state how the Privacy Rule allows provider to use and disclose protected health information. It must also explain that your permission (authorization) is necessary before your health records are shared for any other reason.
- The organization's duties to protect health information privacy.
- Your privacy rights, including the right to complain to HHS and to the organization if you believe your privacy rights have been violated.
- How to contact the organization for more information or to make a complaint.
Patient Comments, Complaints, & Grievances
Comment/Complaint/Grievance Response System Form - this form can be used to submit any comments, complaints, grievances, etc. that you may have about the SNHS related to patient services and experience.
Please click HERE to submit the form electronically or scan the below QR code using the camera app on your smart device.
Please click HERE for a printable version of the form to be mailed or dropped off at any SNHS location.
Patient Release of Information Form
This form must be used to authorize disclosure of protected health information.