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Privacy Notice
To protect your privacy and the privacy of others, DO NOT include PII, PHI, or other sensitive personal information in the Subject or Query fields of this form.
Examples of information that should not be included in your message include:
- Social Security numbers (SSNs)
- Dates of birth
- Patient names or patient registration numbers
- Medical record numbers
- Information about a patient's health condition, diagnosis, or treatment
- Home addresses or personal telephone numbers
- Other sensitive information that could identify an individual
For additional information about protecting PII and PHI, please visit the please visit the IHS Privacy and HIPAA pages.
Required fields are marked with an asterisk (*)
