HELPFUL LINKS
(208) 934-4433      CONTACT US
North Canyon Medical Center
(208) 934-4433
  • About
    • Board of Directors
    • Executive Council
    • Annual Reports
    • Community Benefit Statements
    • Community Health Needs Assessments
    • Legal Notices
  • Services
      • Addiction Treatment
      • Behavioral Health
      • Dermatology
      • Diabetes & Nutrition
      • Diagnostic Imaging
      • Emergency Medicine
      • Family Medicine
      • Foot & Ankle
      • General Surgery
      • Hand & Wrist
      • Laboratory
      • Orthopedics
      • Pain Management
      • Pediatrics
      • Quick Care
      • Rehabilitation
      • Respiratory Therapy
      • Sleep Studies
      • Urology
  • Find a Doctor
      • Addiction Treatment
      • Anesthesia
      • Behavioral Health
      • Cardiology
      • Dermatology
      • Emergency Medicine
      • Family Medicine
      • Foot & Ankle
      • General Surgery
      • Hand & Wrist
      • Hospitalists
      • Nephrology
      • Orthopedics
      • Pain Management
      • Pediatrics
      • Quick Care
      • Radiologists
      • Sleep Studies
      • Urology
  • Patient Info
    • Billing & Payments
    • Financial Assistance
    • Insurance Plans
    • Medical Records
    • Patient Portal
    • Pay Bill Online
    • Pricing Transparency
    • Privacy Rules
  • Giving Back
    • Ways To Give
    • Chapel Construction Project
    • Auxiliary Thrift Store
    • Philanthropy Board
  • Careers
    • Careers at North Canyon
    • Open Positions
  • Locations
    • Buhl Clinic
    • Jerome Clinic
    • Medical Center
    • Specialty Clinic
    • Twin Falls Clinic
    • Maps & Directions
North Canyon Medical Center
  • About
    • Board of Directors
    • Executive Council
    • Annual Reports
    • Community Benefit Statements
    • Community Health Needs Assessments
    • Legal Notices
  • Services
      • Addiction Treatment
      • Behavioral Health
      • Dermatology
      • Diabetes & Nutrition
      • Diagnostic Imaging
      • Emergency Medicine
      • Family Medicine
      • Foot & Ankle
      • General Surgery
      • Hand & Wrist
      • Laboratory
      • Orthopedics
      • Pain Management
      • Pediatrics
      • Quick Care
      • Rehabilitation
      • Respiratory Therapy
      • Sleep Studies
      • Urology
  • Find a Doctor
      • Addiction Treatment
      • Anesthesia
      • Behavioral Health
      • Cardiology
      • Dermatology
      • Emergency Medicine
      • Family Medicine
      • Foot & Ankle
      • General Surgery
      • Hand & Wrist
      • Hospitalists
      • Nephrology
      • Orthopedics
      • Pain Management
      • Pediatrics
      • Quick Care
      • Radiologists
      • Sleep Studies
      • Urology
  • Patient Info
    • Billing & Payments
    • Financial Assistance
    • Insurance Plans
    • Medical Records
    • Patient Portal
    • Pay Bill Online
    • Pricing Transparency
    • Privacy Rules
  • Giving Back
    • Ways To Give
    • Chapel Construction Project
    • Auxiliary Thrift Store
    • Philanthropy Board
  • Careers
    • Careers at North Canyon
    • Open Positions
  • Locations
    • Buhl Clinic
    • Jerome Clinic
    • Medical Center
    • Specialty Clinic
    • Twin Falls Clinic
    • Maps & Directions

Authorization to Obtain/Release Medical Records

Authorization to Obtain/Release Medical Records
  • MM slash DD slash YYYY
  • This is to authorize the described medical records to the the above patient...

  • Please enter where you would like the records to be released from:

  • Records Requested (check all that apply)

  • From:
    MM slash DD slash YYYY
  • To:
    MM slash DD slash YYYY
  • Please enter where you would like the records to be released to:

  • Records Requested (check all that apply)

  • Initial To Authorize
  • Initial To Authorize
  • Initial To Authorize
  • Accepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.
  • THIS AUTHORIZATION MAY BE REVOKED AT ANYTIME IN WRITING. TO REVOKE, THE PATIENT MUST SUBMIT A LETTER REQUESTING THE AUTHORIZATION BE REVOKED TO THE DIRECTOR OF HEALTH INFORMATION. RELEASING YOUR MEDICAL INFORMATION AS A RESULT OF THIS AUTHORIZATION MAY MEAN THAT YOUR MEDICAL INFORMATION COULD BE RERELEASED BY THE RECIPIENT AND NO LONGER BE PROTECTED BY FEDERAL PRIVACY RULES.
  • MM slash DD slash YYYY

Mission

Powered by excellence, we are growing a medical organization that serves our communities.

Vision

We aspire to be your first choice for healthcare through an expanded network of medical services of the highest quality.
  • Notice of Privacy Practices (HIPAA)
  • Google Privacy Policy
  • Terms of Use
  • Contact Us

The North Canyon Medical Center website is for informational and educational use only. The information contained in this site should not be construed as medical advice or instruction. If you need medical advice, please call 911 or contact your healthcare provider.

North Canyon Medical CenterCopyright © 2022 North Canyon Medical Center
267 N Canyon Dr, Gooding, ID 83330
(208) 934-4433 • info@northcanyon.org
Go to Top
North Canyon Medical Center

Patient Portal

Billing & Payments

IT Access

Contact Us

  • About
    • Board of Directors
    • Executive Council
    • Annual Reports
    • Community Benefit Statements
    • Community Health Needs Assessments
    • Legal Notices
  • Services
    • Addiction Treatment
    • Behavioral Health
    • Dermatology
    • Diabetes & Nutrition
    • Diagnostic Imaging
    • Emergency Medicine
    • Family Medicine
    • Foot & Ankle
    • General Surgery
    • Hand & Wrist
    • Laboratory
    • Orthopedics
    • Pain Management
    • Pediatrics
    • Quick Care
    • Rehabilitation
    • Respiratory Therapy
    • Sleep Studies
    • Urology
  • Find a Doctor
    • Addiction Treatment
    • Anesthesia
    • Behavioral Health
    • Cardiology
    • Dermatology
    • Emergency Medicine
    • Family Medicine
    • Foot & Ankle
    • General Surgery
    • Hand & Wrist
    • Hospitalists
    • Nephrology
    • Orthopedics
    • Pain Management
    • Patient Portal
    • Pediatrics
    • Quick Care
    • Radiologists
    • Sleep Studies
    • Urology
  • Patient Info
    • Billing & Payments
    • Financial Assistance
    • Insurance Plans
    • Medical Records
    • Patient Portal
    • Pay Bill Online
    • Pricing Transparency
    • Privacy Rules
  • Giving Back
    • Ways To Give
    • Chapel Construction Project
    • Auxiliary Thrift Store
    • Philanthropy Board
  • Careers
    • Careers at NCMC
    • Open Positions
  • Locations
    • Buhl Clinic
    • Jerome Clinic
    • Medical Center
    • Specialty Clinic
    • Twin Falls Clinic
    • Maps & Directions