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 person or address
Authorization to Use and Disclose Health Information Form
|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.
HIM ROI Department
1115 SE 164th Avenue, Dept. 336
Vancouver, WA 98683
Phone: (360) 752-5111
Fax: (541) 431-8265