Patient Addition or Removal Request
An accurate patient record is critical to ensuring timely and appropriate health care. When providers move/retire, patients change health care providers, or data entry errors occur, this may result in records being misdirected. The encrypted form below allows physicians and health care professionals to securely report errors and updates.
- Access the Patient Removal Request form to:
- Add a provider or transfer care
- Report a misdirected fax or remove provider from IH records
These forms are intended to be used solely for official purposes by authorized personnel. Unauthorized access or use may subject violators to criminal, civil and administrative actions.