Our Release of Information staff will be happy to assist you with requests for your medical records. They are also experts in patients' rights. We also assist providers with completing forms for patients. We can assist you with the following:
To request a medical record, please complete one of the forms listed in the column to the right, fill out the requested information, sign the form, and mail it to the following address:
Because forms must contain an original signature, e-mailed forms cannot be accepted.
Depending on the request, medical records could take up 10-14 days to process.
Consent or authorization for release of information by a specific individual, physician or insurance company allows the hospital to send copies of information contained in a patient's medical record to another provider who may also treat the patient, to other agencies/organizations for benefits consideration, or to the patient him/herself.
There is no cost to send copies directly to another health care provider. If copies are for a patient's personal use, photocopying fees may be assessed.
The Release of Information supervisor may be contacted by calling (928) 445-4860 ext. 6227.