Release of Medical Information


We understand the importance of maintaining our patients’ privacy and protecting their medical information. The Health Information Portability and Accountability Act (HIPAA) became effective on April 14, 2003. The regulations specifically outline various protocols regarding the handling of a patient’s medical information and detail the requirement for all healthcare providers (transmitting insurance claims electronically) to notify patients of how their medical information could be used and/or disclosed. To comply with these regulations we have developed our Notice of Privacy Practices. If you have any questions regarding this Notice or our privacy practices in general, please feel free to call our Privacy Officer at (317) 471-4451.

To download and print a copy of Indiana Hand to Shoulder Center’s medical information release form please click on the appropriate version below. You will need Adobe Acrobat Reader to view the forms. If you do not have Adobe Acrobat Reader, please download the free program.

Download Release of Information Form (118 KB PDF)

Download Notice of Privacy Practices (160 KB PDF)









M - F:  8am - 5pm

Saturday, early morning, and evening appointments available at Northside location.


Evening appointments available at the Southside location.

Copyright 2019 Indiana Hand to Shoulder Center

 Indiana Hand to Shoulder Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Download IHTSC Discrimination Policy.