Release of Information

This Release of Information form is required in order to authorize the Behavioral Health Wellness Clinic (BHWC) to use and disclose health information and substance use disorder treatment information with your treating health care providers. 

This form will only release information from your health record from your care at the ANTHC Behavioral Health Wellness Clinic. To obtain your medical records from the Alaska Native Medical Center, please complete the ANMC Medical Record Request form.