IF YOU ARE A NEW PATIENT,
PLEASE DOWNLOAD AND FILL OUT THE SETS OF FORMS LINKED BELOW
Note: If you are a new patient planning on transferring your care to Bella Natural Women’s Care & Family Wellness, please complete the medical records form and e-mail it us PRIOR to your scheduled appointment time.
MEDICAL RECORDS FORM
IF YOU ARE REQUESTING OR RELEASING YOUR MEDICAL RECORDS, PLEASE FILL OUT THIS FORM AND EMAIL IT TO firstname.lastname@example.org
Note: Please allow 7-10 days to transmit your records from Bella Natural Women’s Care & Family Wellness to another provider.
CIIS REGISTRY INFORMATION:
The Colorado Immunization Information System (CIIS), also known as the state immunization registry, is a confidential, computerized, population-based system that collects and consolidates immunization data for all persons born, residing in or receiving immunizations in the State of Colorado and provides tools for designing and sustaining effective immunization strategies at the provider and program levels. CIIS is an important tool to increase and sustain high vaccination coverage by consolidating patient vaccination records from multiple providers and providing official vaccination forms and vaccination coverage assessments. The Colorado Department of Public Health and Environment (CDPHE) operates CIIS pursuant to the Immunization Registry Act -Colorado Revised Statute (CRS) § 24-4-2403.
The Immunization Registry Act provides for the disclosure and use of immunization information in order to meet statutory immunization requirements and to control disease outbreaks. It is the official duty of CDPHE and local public health agencies to use the birth certificate of any person to enroll the person in CIIS.
The purpose of this policy is to address the need to provide appropriate confidentiality protections of the information in CIIS as well as explain the privacy rights of individuals to exclude their information from CIIS. Privacy relates to the control individuals exert over their personal information; whereas, confidentiality relates to ensuring that information is accessible only to those authorized to have access.
Note: This policy does not cover non-immunization related data and, as such, provider access to the Newborn Hearing/Newborn Screening module within CIIS. Providers are required to sign and abide by a separate Newborn Hearing/Newborn Screening Confidentiality Agreement provided by the Early Childhood Screening program at CDPHE.
Please reference the following links and attachments for further information.
CIIS opt-out procedures: https://www.colorado.gov/pacific/cdphe/ciis-opt-out-procedures