Forms

AHHN Helpline: 312.971.3044

The Helpline is staffed seven days a week: Monday through-Friday, 9 a.m. to 9 p.m. and from 8 a.m. to 6 p.m. on Saturday and Sunday.

All Hands Health Network

211 East Chicago Avenue
Chicago, Illinois 60611-2605
312.971.3044

This program is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $8 million with 0 percentage financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS, HHS or the U.S. Government.

Forms

Consent and Authorization

Release of Information (English PDF)

Release of Information (Spanish PDF)

AHHN Consent & Authorization to Share Information Form (English)

Consentimiento y autorización para compartir información (Spanish)

AHHN Helpline: 312.971.3044