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Notice of
Privacy Practices

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Authorization to Release
Medical Records - Electronic Version

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Registration- Permission to Disclose Protected Health Information (PHI) to Designated Individuals

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Clinical Student
Application

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Authorization to Release
Medical Records - Printable Version

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Registration - Consent to Treat Patient-Without Legal Guardian or Authorized Agent Present

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Permission to Disclose Protected Health Information (PHI) to Designated Individuals

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©2025 Muskingum Valley Health Centers. All rights reserved.

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This institution is an equal opportunity provider. MVHC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. 

MVHC is a Federally Qualified Health Center and an FTCA Deemed Facility. This health center receives HHS funding and has Federal PHS deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals. 

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