Patient Forms - Mendocino Coast Clinics

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.