Patient Forms

Medical and Billing Record Release Forms

Use these forms when requesting transfer of your medical and billing records to or from another provider or to obtain a copy of your records:

• TriHealth (any entity) Authorization to Disclose PHI Form (PDF)
• TriHealth (any entity) Authorization to Disclose Billing Records Form (PDF) 

General Patient Information - Optional

• TriHealth Joint Notice of Privacy Practices |  en Espanol (PDF)
• Patient Rights and Responsibilities  
• Speak Up (PDF)
• Ohio Health Care Power of Attorney (PDF)
• Ohio Living Will (PDF)
• Practice Information en Espanol