Medical Records from United General Medical Center | PeaceHealth

Medical Records from United General Medical Center

 
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

 English

Request for Access to or
Copies Form

Authorization to Use and Disclose Health Information Form

Guide to Complete Form

 Spanish

Request for Access to or
Copies Form - Spanish

Authorization to Use and Disclose Health Information - Spanish

Visually Impaired

Request for Access to or
Copies Form - Visually Impaired

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.

Contact Information

PeaceHealth 
HIM ROI Department
1115 SE 164th Avenue, Dept. 336
Vancouver, WA 98683
Phone: (360) 729-1300 
Fax: (360) 756-4871
PeaceHealth United General Medical Center
2000 Hospital Dr
Sedro-Woolley, WA 98284
360-856-6021

For Families & Friends