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.
 

 

Request a copy of my medical records

English

Request for Access or Copies

Spanish

Request for Access or Copies - Spanish

Visually Impaired

Request for Access or Copies - 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
PeaceHealth
HIM ROI Department
1115 SE 164th Avenue, Dept. 336
Vancouver, WA 98683 


Phone: (360) 729-1309
Fax: (541) 431-8265