NV.gov
Request For Information
Form
Confidentiality
The confidentiality of a cancer record is protected under NRS 457 and NAC 457. Consent is required before disclosure of any information.
Consent
- Consent may be verified with one of the following documents:
- Direct consent from patien
- 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)
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)
Send Requests
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.