Health Records


To transfer your records, complete the appropriate form below.
You can do this online or by downloading and filling in the form by hand.

If you are currently a patient wishing to transfer healthcare services to CHC/SEK, it is necessary to get your approval for the transfer of your records to CHC/SEK. Parents and guardians may complete a release of medical records for patients who are under 18 years old.

All CHC/SEK Clinic Patients


Complete the online version

Release of Information
English
Spanish

Demographics Form
English
Spanish

Download the forms and complete by hand

Release of Information
English
Spanish

Demographics Form
English
Spanish

Submit Forms

Downloaded forms can be returned to clinic staff, faxed to 620-231-5062, or mailed to:
CHC/SEK
P.O. Box 1832
Pittsburg, KS 66762