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Release of Information Form Repository

Below are links to ROI forms for Santa Cruz community providers. 


Providers and Community Partners can use these forms to request that an organization share protected health information.

Please contact if you have any questions or are interested in adding your organization’s ROI forms to the repository. 

          Streamlining processes for sharing client/patient information is a critical element of effective care coordination. Having access to a release of information (ROI) form is essential in making sure that information is being shared legally and appropriately.

          While the ultimate goal is to make signed and completed ROI forms for individual clients/patients available through a secure, electronic and accessible system, that is a long term project. As an interim way to address the challenges of information sharing, HIP has created a repository of template release of information forms that will be accessible to all. The purpose of the repository is at least twofold:

1. Care coordinators can look up an ROI form to see if it covers the type of information that is being requested to be shared

2. Organizations that want to improve their own ROI will have examples to look to for inspiration.

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