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 (pdf)

Authorization to Use and Disclose Health Information Form (pdf)

Guide to Complete Form (pdf)

 Spanish Request for Access to or Copies of Form - Spanish (pdf) Authorization to Use and Disclose Health Information Form - Spanish (pdf)
Visually Impaired Request for Access to or Copies of  Form - Visually Impaired (pdf) Authorization to Use and Disclose Health Information Form - Visually Impaired (pdf)​

 

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

PeaceHealth Medical Group
Sedro-Wolley
2000 Hospital Drive
Sedro-Woolley, WA 98226
Phone: (360) 856-6021​​​
Fax: 

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