Authorization for Disclosure of Protected Health Information
Securely authorize Rock Ridge Pharmacy to release your protected health information to the person or organization you designate.
Complete Your HIPAA Authorization
The secure BESTRx form guides you through the information needed to authorize the disclosure of your protected health information.
Patient Information
Enter your name, date of birth, address, and contact information.
Recipient Details
Identify the person or organization authorized to receive your information.
Select Records
Choose the protected health information you authorize for disclosure.
Review & Sign
Review the authorization and submit your electronic signature securely.
Ready to complete your authorization?
The form will open securely in a new window. Follow the instructions provided to complete and submit your authorization.
Need assistance?
Contact Rock Ridge Pharmacy if you have questions about completing the form.