Logo
Menu
  • Home
  • Departments
    • Health & Wellness
    • Head Start
    • Women, Infants & Children
    • Elderly Services
    • Family Services
    • Natural Resources
    • Education
    • Public Improvement Authority
    • Tribal Court
    • Tribal Enrollment Program
    • Child Care
    • Human Resources
  • Our Pueblo
    • History
    • Gallery
    • Black Mesa Casino
    • Careers
    • Downloadable Forms
  • Events
  • Announcements
  • Contact
Downloadable Forms

Downloadable Forms

Home / Our Pueblo / Downloadable Forms

NPP acknowledgment form

Accounting of Disclosure

Authorization to Disclose and Obtain PHI

Request for Amendment of Health Records

Request for Restriction of PHI

Revocation of the Request for Restriction

San Felipe Pueblo

Menu

  • Home
  • Departments
  • Our Pueblo
  • Events
  • Announcements
  • Contact

Contact Us

  • (505) 867-3381
  • Send Us A Message
  • Downloadable Forms

Open Positions

  • SURVEILLANCE MANAGER
  • LEA Prevention Specialist-Certified Peer Support Worker-High School
  • LEA Prevention Specialist-Certified Peer Support Worker-BPS
  • Case Manager
  • View All

© 2023 by San Felipe Pueblo. All rights reserved.

Notice of Privacy Practices Website Design by Xynergy