Skip Ribbon Commands
Skip to main content
Longview/Castle Rock, WA Locations

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 Form 

Authorization to Use and Disclose Form

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