Request For Information

• Request For Information Form

The confidentiality of a cancer record is protected under NRS 457 and NAC 457. Consent is required before disclosure of any information. 

Consent may be verified with one of the following documents:

§  Direct consent from patient

§  Consent from health care provider/facility that diagnosed or treated the patient

§  Power of attorney (certified copy)

§  Legal Guardianship (certified copy)

§  Executor status of an estate (certified copy)

§  Court order (certified copy) 

In order to process your request, the following must be included with your request:

§  Completed request for information form

§  Consent documents 

§  Photocopy of the requestors identification (ID)

Request’s may be emailed to dpbhNCCR@health.nv.gov , faxed to (775) 684-5999, or mailed to 4126 Technology Way, Suite 200, Carson City, Nevada 89706.