Patient Forms - Mendocino Coast Clinics

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Medical Records Request Forms
California Advance Health Care Directive Forms

Medical Records Request Forms

ONLINE VERSION
Fill out the form, save to your computer, and email PDF to medicalrecords@mccinc.org. NOTE: This email address is ONLY for medical records.
Records Release – English
Records Release– Spanish

PRINT VERSION
Record Release – English
Record Release – Spanish

California Advance Health Care Directive Forms

PRINT VERSION
Advance Health Care Directive Form – English
Advance Health Care Directive Form – Spanish

Copyright by Mendocino Coast Clinics. All rights reserved. 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. This Health Center is a Health Center Program grantee under 42 U.S.C. 245b, and deemed a Public Health Service employee under 42 U.S.C. 233 (g)-(n). Any claim filed against MCC must be done in federal court.