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Policies and Forms

Medical Release of Information

Harbor Health maintains a medical record for each of its patients. The record contains a history of the healthcare provided by Harbor Health. In some cases, it will contain information that has been transferred to us by another provider.

Medical records are confidential and are the property of Harbor Health. Patients have the right to request a copy of their medical record and to inspect that record.

Harbor works with ScanSTAT Technologies to manage medical record requests.

Proper authorization must be on file. One of the following methods may be used to request the record.

  1. The patient, legal guardian or legal representative can complete a Medical Record Release Form during a visit with a provider.
  2. The patient can sign a release of information at another facility or provider and have the request sent to Harbor.
  3. The patient, legal guardian or legal representative can complete a request online.

Request Medical Records

Authorization must be signed in the following manner:

  1. By the patient, legal guardian or legal representative.
  2. By the parent, if the patient is under 18 years of age and not labeled *emancipated, enumerated or mature minor.* Parents without legal custody of their children do have the right to the medical information about his/her child unless otherwise mandated by court order.

Harbor Health Policies

Patient Rights & Responsibilities

Notice of Privacy Practices

Digital and Social Media Policy

This health center receives HHS funding and has federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.


If you would like to file a complaint by speaking to one of our staff directly, please contact us and ask to speak to a member of our administration. Formal complaints can be lodged with our administrative department and will be responded to promptly.

Harbor Health Services, Inc. also offers a compliance hotline where anonymous complaints can be filed. Our hotline is available 24 hours a day. Please call 1-833-310-0040. We will not retaliate against you for filing a complaint.

If you have a concern regarding your rights as a patient or a breach of patient information, please contact our privacy officer:

Jesse Shipley
[email protected]

If you feel as though your concerns are not adequately resolved by a member of our staff, you may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by calling 1-877-696-6775 or with the Joint Commission by calling 1-603-792-5000.