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Release of Information

The Walla Walla Clinic respects your privacy. We understand that your personal health information is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law allows us to do so.

Processing of this electronic Release of Information is offered when coordinating care between the Walla Walla Clinic and another provider.

An authorization form is available from any receptionist at the Walla Walla Clinic or by filling out the Online Release of Information Form now.

If you wish to have records released for personal use, please print this Signable Release of Information Form.

Please fill out forms completely and return them to the Walla Walla Clinic, or they can be mailed to:

Walla Walla Clinic
Attn: Release of Information Department
55 W. Tietan St.
Walla Walla, WA 99362

If you are releasing your records to another provider, this process will take no more than 15 days and there is no processing fee. If you are requesting a copy for your personal records, it will take about 15 days and a processing fee will be charged.

Please feel free to call us at 509.525.3720, ext. 1220, during our normal business hours if you have any questions. You may email the release of information clerk at roi@wallawallaclinic.com or send a fax to 509.525.6897.

Nondiscrimination

Walla Walla Clinic complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Walla Walla Clinic does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Walla Walla Clinic:

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Provides free language services to people whose primary language is not English, such as:
    • Qualified interpreters
    • Information written in other languages

If you need these services please contact our clinic Interpreter, or Administration, at 509.525.3720.

If you believe that Walla Walla Clinic has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you have the right to file a grievance with:

Walla Walla Clinic Administration
55 W Tietan St., Walla Walla, WA 99362
509.525.3720, Fax 509.522.1593

You may file a grievance in person, phone, mail or fax. If you need assistance filing a grievance please contact our clinic Interpreter, or Administration at the number above.

You may also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW Room 509F,
HHH Building
Washington, D.C. 20201
1.800.368.1019, 800.537.7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

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ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1.509.525.3720, 1221

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