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:
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.
Request Restriction of your Protected Health Information
To Request Restriction of your Protected Health Information, please choose the appropriate form.
Request for Amendment of Protected Health Information
Request for Alternate Communications of Protected Health Information
PHMG Family and Friends Information Form