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For Patients, Families & Visitors > Patient Services

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 medical records to me

Send a copy of my medical records to another address or person
 English Request for Access to or Copies Authorization to Use and Disclose Health Information
Guide to Complete Form
 Spanish Request for Access to or Copies - Spanish Authorization to Use and Disclose Health Information Form - Spanish
Visually Impaired Request for Access to or Copies - 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

St. John Medical Center &
PeaceHealth Medical Group
P.O. Box 3002
Longview, WA 98632-0302
Phone: (360) 414-7811
Fax: (360) 414-7796