Patient Forms

Release Forms
Forms may be emailed to himdept@onecommunityhealth.com or faxed to the Medical Records Department at (916) 325-1984. Medical records can also be requested through MyChart.

Medical Records or Health Information Form – English: Form | Instructions
Medical Records or Health Information Form – Spanish: Form | Instructions
Medical Records or Health Information Form – Dari: Form | Instructions
Medical Records or Health Information Form – Pashto: Form | Instructions

Right of Access: Authorization to Discuss Your Information with Others – English
Right of Access: Authorization to Discuss Your Information with Others – Spanish
Right of Access: Authorization to Discuss Your Information with Others – Dari
Right of Access: Authorization to Discuss Your Information with Others – Pashto

Sliding Fee Forms
Sliding Fee Discount Application – Self Declaration – English
Sliding Fee Discount Application – Self Declaration – Spanish

Notice and Service

Non-Discrimination Notice
Language Assistance Services
Patient Notices & Policies