Medical Records from St. Mary Medical Center
Medical records are maintained by the hospital for the time period required by the State of California.
How to Request a Copy of your Medical Record
According to the State of California’s Confidentiality of Medical Information Act, the hospital must receive a complete and properly executed Authorization before providing a copy of the patient’s records to anyone, including the patient. In certain cases, a patient’s physician or psychologist may also be required to approve a request. Authorizations signed by a patient representative must include a copy of the durable power of attorney, guardianship, etc.
Most requests are processed in 7-10 business days. Large requests may require additional time and are processed by the hospital’s contracted vendor. Please note there may also be a fee associated with large requests. If you have any questions regarding the fees, please call 760-242-2311 Ext. 6115.
You may download, print and complete the Authorization for Use or Disclosure of Health Information:
Complete all sections of the authorization form:
- Indicate the dates of treatment/admissions for which you are requesting information
- Indicate the type of records needed, i.e. Lab results, x-rays
- Initial specific sections on form if requesting information regarding HIV test results, Mental Health treatment or Alcohol/Drug treatment
- Indicate if Radiology/Imaging CDs are needed and date and type of image: Chest X-ray, CT, MRI. Please note there may be a fee associated with burning of CDs.
Mail, email or fax your completed request to:
Providence St. Mary Medical Center
Health Information Management Department
Attn: Release of Information
18300 Highway 18
Apple Valley, CA 92307
Hours of operation
Monday - Friday, 8 a.m. - 4:30 p.m. (closed weekends and holidays)
You can also access and download a portion of your health information from your latest inpatient hospital stay on-line through the MyChart patient portal.
If picking up records in person, photo ID is required. The patient may sign a letter authorizing another individual to pick up the medical records. This individual must present the letter, patient authorization and provide photo ID.