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Authorization Forms

To request a copy of your medical/dental records you will need to obtain, complete and submit an Authorization for Release of Health Information form.

To give permission to share information with Family, Friends, and Caregivers you will need to obtain, complete and submit a Permission to Share Information with Family, Friends, and Caregivers form.

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© 2023 Marin Community Clinic. All Rights Reserved.
Marin Community Clinics receives HRSA Health Center Program grant funding under 42 U.S.C § 254b and has been deemed a Public Health Service employee for purposes of certain liability protections, including Federal Tort Claims Act coverage, under 42 U.S.C § 233(g)-(n).

  • facebook
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Close Menu
  • Services
    • Primary Care
    • Reproductive Health
    • Dental
    • Behavioral Health
    • Specialty Services
    • Wellness Services
    • Support Services
  • Patient Resources
    • Find a Provider
    • New Patients
    • Medical Records
    • Resources
    • FAQ
    • HIPAA NPP (English)
    • HIPAA NPP (Spanish)
  • Locations
    • Larkspur Clinic
    • Novato Campus Clinics
    • Fourth Street Clinic
    • San Rafael Campus Clinic
    • San Rafael Clinic
    • Greenbrae Clinic
    • Teen Clinics
  • Company
    • About Us
    • News/Events
    • Donor’s Corner
    • Contact Us
    • Leadership Team
    • Board of Directors
    • Careers
  • facebook
  • linkedin
  • youtube
  • instagram