Request Records

The Referrals and Records team is responsible for the maintenance and confidentiality of all patient records and are committed to protecting the rights of our patients and families. We maintain medical records to help serve our patients, healthcare providers, and to meet legal, accrediting, and regulatory requirements.

A patient’s medical records will only be released with proper authorization from the patient or the patient’s legal representative. Records can be released to anyone whom the patient authorizes (in writing) to receive them. If an expiration date is not noted, the authorization is valid for one year.

You can also access your personal health records online at any time in our patient portal.

Federal privacy rules (Health Insurance Portability and Accountability Act, or HIPAA) allow for up to 15 days to respond to requests for medical records

Request Your Medical Records

Please complete the form below to begin the medical records process:

Patient Name

First Name Last Name

Patient Date of Birth

Patient Email

Patient Phone Number

Requestor's Name

First Name Last Name

Relationship to Patient (If Not Self)

Type of Records Requested

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NOTE

Please note that this form is not an official medical records request. Please complete this form to begin the request process with our medical records team. After completing this form, a representative will be in touch to complete your official request.

Request Your Medical Records

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