Forms and Publications

ar13frontcover
YKHC's Report to the People, 2013.

Publications

Provider Resources

2013 Clinical Guidelines (PDF 4mb). Guidelines are designed for general use for most patients but may need to be adapted to meet the special needs of a specific patient as determined by the patient’s provider.

Pediatric Orientation Manual (PDF 40mb)
Resource and procedure manual for Pediatricians.

 Retail Store

Referral Forms

Refer a patient or client to one of our clinics, specialty clinics or service programs.

Release Forms

Authorization to Release Patient Psychotherapy Notes (PDF)

Behavioral Health Services
P.O. Box 528 • Bethel, Alaska 99559
Phone: 907-543-6100 • Fax: 907-543-6159

This notice accompanies a disclosure of information concerning a client in alcohol/ drug abuse treatment, made to you with the consent of such client. This information has been disclosed to you from records protected by Federal confidentiality rules (42 CFR Part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient.

Authorization To Release Patient Behavioral Health Information (PDF)

Behavioral Health Services
P.O. Box 528 • Bethel, Alaska 99559
Phone: 907-543-6100 • Fax: 907-543-6159

This notice accompanies a disclosure of information concerning a client in alcohol/ drug abuse treatment, made to you with the consent of such client. This information has been disclosed to you from records protected by Federal confidentiality rules (42 CFR Part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient.

Authorization To Release Human Resources Information (PDF)

Human Resources Dept.
P.O. Box 528 • Bethel, Alaska 99559
Phone: 907-543-6060 • Fax: 907-543-6061

Authorization To Release Specific Patient Information (PDF)

Health Information Services Dept.
P.O. Box 287, Suite 3016, Bethel, Alaska 99559
Phone: 907-543-6388 Fax: 907-543-6417

Authorization To Release Patient Health Information (PDF)

Health Information Services Dept.
P.O. Box 287, Suite 3016 • Bethel, Alaska 99559
Phone: 907-543-6388 • Fax: 907-543-6417

MEDIA Authorization & Waiver of Liability (PDF)

Authorization to Take & Use Photographs, Video Tapes, and/or Audio Tapes & Information