Instructions:
1) Click the link below to open the form in a new window.

Hippa Release Form

2) Print the form.
3) Mail the completed form to:

Privacy Officer
Conway Medical Center
PO Box 829
Conway, SC 29528

Instructions:
1) Click the link below to open the form in a new window.

Hippa Release Form

2) Print the form.
3) Mail the completed form to:

Privacy Officer
Conway Medical Center
PO Box 829
Conway, SC 29528