Attached to the right are the General and Behavioral Health (BH/DA) patient Authorization forms for the Use and Disclosure of Protected Health Information (PHI).

Click on the reports to the right to open and print the forms.

• Authorization for Warren General Hospital to use or disclose your protected health information to other entities
• Authorization for other entities to disclose your protected health information to Warren General Hospital 
• Behavioral Health/Drug and Alcohol Authorization for other entities to disclose your protected health information to Warren General Hospital
• Behavioral Health/Drug and Alcohol Authorization for Warren General Hospital to use or disclose your protected health information to other entities