Medical Records Request

To receive a copy of your health information, you may complete the Patient Request for Access form, write a letter, or submit a request via your MyChart account. To release your records to a 3rd party, please use the Authorization for Disclosure form.

• Patient Request for Access form
• Authorization for Disclosure form

Formularios para autorización para liberar información de salud:

• Autorización para usar o divulgar información médica protegida

• Solicitud del paciente para acceder al conjunto de registros designado

If you choose to write a letter, it must include the following required elements:

• Signed by the individual (patient)
• Clearly identify the patient, preferably name and date of birth
• Clearly identify the person designated to receive the records
• Identify what records are to be included

To request a chart correction to your medical record (amend a designated record set), please fill out and submit the form:

• Patient Chart Correction Form

Fax, mail or email your completed and signed form to

Release of Information – HIM
800 Swift Blvd
Suite 180
Richland, WA 99352

Fax: 509-392-5682
Send an email

No walk-ins, the office is closed to the public. Please call 509-942-2017 Mon - Fri 8 a.m. - 4:30 p.m. for assistance.