Medical Records Request Forms
Use the following forms to request medical records for yourself or someone who has given you written permission.
- Authorization to Disclose Protected Health or Billing Information
- Autorización para divulgar información médica protegida o de facturación (Spanish)
- Instructions for Completing the Authorization to Disclose Health or Billing Information Form
- Request to Exercise Privacy Rights Amendment of Medical Record
- Request to Exercise Privacy Rights Restrict the Use or Disclosure of PHI