CCPA Consumer Request Form

The California Consumer Privacy Act of 2018 (“CCPA”) provides California residents with specific rights regarding their personal information. As a California resident, you may exercise these rights by completing the below form. Note that we may ask for additional information or documents to verify your identity prior to processing your request. Please visit our Privacy Policy and CCPA Notice to learn more about how we collect, handle, use, and protect your personal information.

We reserve the right to refuse requests for various reasons, including: (a) to the extent permitted by law; (b) if we are unable to verify your identity; or (c) if we cannot verify your authority to act on behalf of another person.

Please submit your request through the form below.

    CCPA Consumer Request Form

    Please Select Who the Request Is Being Made For:

    If you are completing this form as an Authorized Agent, please complete and send us a California Authorized Agent Designation Form.

    If you are submitting this form as an Authorized Agent, please complete the following information:

    By checking “I Accept” below, you acknowledge and certify that the information you have entered into this form is complete and accurate to the best of your knowledge and that you are either (a) a California resident making this request on behalf of yourself; or (b) an Authorized Agent making this request on behalf of a California resident, as indicated above. You understand that it may be necessary for us to further verify the identity of the California resident and/or the Authorized Agent and you agree to comply with any such requests.

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    I have really enjoyed working with the knowledgeable and innovative staff within Mission Control! They have observed and created a dashboard that significantly meets our data abstraction needs. This information is in real time and we can access the data points we need very quickly. Mission Control has saved me hours of manual abstraction and I can now present this information to our physicians and leadership through creative charts and graphs. At Newman Regional Health, we are very excited to integrate Mission Control into our daily workflow and look forward to the valuable information the dashboard can provide!

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    We started using Mission Control a few months ago because we were struggling with finding patient placement and transportation. Mission Control helped with that significantly. MC is very user friendly! All staff has been so kind and helpful! They are always prompt with assisting us and do a great job in keeping us up to date and informed on any progress they’re making whether that be with a phone call or a message through mission control. They continue to work until transport has been found! We would be lost without them!

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