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For Patients, Families & Visitors

Patient Services

Health Information Management/Medical Records

To request a copy of your medical records please select the appropriate form below. Print, complete, sign and date the form, then mail or fax it to the contact information listed below. If you are mailing a request, write "Attention Health Information Management- ROI" on the envelope.

Upon receipt of the completed form, we will either promptly process your request or contact you if further information is needed. If a fee is assessed for processing the requested records, you will be called in advance.

 

Send a copy of my record
to me

Send a copy of my record to
another address or person
 English Request for Access to or Copies Form

Authorization to Use and Disclose Health Information Form

Guide to Complete Form
 Spanish Request for Access or Copies to Form - Spanish Authorization to Use and Disclose Health Information Form - Spanish
Visually Impaired Request for Access or Copies to Form - Visually Impaired Authorization to Use and Disclose Health Information Form - Visually Impaired

 

If you have questions about obtaining copies of medical records, the address, phone and fax numbers for the Release of Information staff are listed below.

Contact Information
Sacred Heart Medical Center
P.O. Box 10905
Eugene, OR 97440
Phone: (541)686-6841
Fax: (541)335-2519