Formally known as Medical Records Department
Hours of Operation
8:00 am-5:00 pm
To request copies of your medical records, please complete the attached Authorization to Use or Disclose Health Information and mail the completed form to the address listed at the top of the form. A charge of $0.25 per page may apply. You will be notified of any charges when we receive your signed authorization. Please include your telephone number and a copy of your photo ID with the authorization.
Please note: The execution of this form does not authorize the release of information other than that specifically described on the authorization. The form authorizes release of information in accordance with the Health Insurance Portability and Accountability Act, 45 CFR Parts 160 and 164. Your disclosure of the information request in this form is voluntary.