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Forms & Records

Health Information Management

Riverside-San Bernardino County Indian Health, Inc. (RSBCIHI) is committed to protecting your health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Our Notice of Privacy Practices explains how your healthcare information may be used and disclosed in the course of our business and details your rights to access this information.

Need Assistance?

(866) 640-3532

Quality Management/Compliance

If you have questions or need assistance with accessing or releasing your records, please don’t hesitate to reach out to our team. Our goal is to make managing your health information as straightforward as possible.

Accessing Your Health Records

RSBCIHI offers several convenient ways to obtain your health records:

  • Patient Portal
  • Encrypted Email
  • USPS Mail
  • In-Person Pickup

You can request records at any RSBCIHI location using any of these methods.

HIPAA Authorization Form Information

To release your medical records to a designated recipient, RSBCIHI requires a completed HIPAA Authorization Form. This document must meet all California State and Federal requirements for us to process your request. Please ensure all information is accurate and complete to avoid delays.

Required Information on the Authorization Form:

  • Patient’s Full Name and Date of Birth
  • Recipient’s Name and Address (where records will be sent)
  • Purpose for Release (e.g., Continuity of Care, Legal Matter, Personal Use)
  • Specific Health Information to be released
  • Date Range of Records
  • Format for Disclosure (e.g., digital or paper)
  • Expiration Date of the Authorization
  • Patient or Legal Representative’s Signature (and photo ID if required)
  • Supporting Legal Documentation for patient representatives, such as Legal Guardianship or Power of Attorney
  • Please note: The form must be completed accurately and include all required information to ensure timely processing.y.