Forms
- Analysis and Service Request Form
- Authorization for Disclosure of PHI: English | Spanish
- Authorization for Disclosure of PHI - Murrieta: English
- Authorization for Disclosure of PHI for Mental Health (Non BMC): English | Spanish
- Authorization for Release of PHI Behavioral Medicine Center: English | Spanish
- Certified Data Release Department (CDRD) Forms
- Computer Access request/Delete Form
- Computer Workstation Rules of Conduct
- Data Request Form | FAQ
- Health information exchange electronic network opt-out consent: English | Spanish
- Health information exchange electronic network revocation of opt-out: English | Spanish
- MyLLU Health Proxy Authorization: Adults - English | Spanish | Adolescents - English | Spanish
- Notice of Privacy Practices
- Other Facility Records Cover Sheet
- Request for Special Restriction on Use or Disclosure of Protected Health Information
- Restraining Order Attestation and Acknowledgement of Receipt for Minors - English | Spanish
- Request to Amend Protected Health Information: English | Spanish
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