Medical Records from St. Mary Medical Center, Apple Valley
To receive copies of your medical records, you must submit a written, signed, and dated request form. You may download, print and complete the Authorization for Use or Disclosure of Health Information in English or in Spanish.
Mail, fax, or hand-deliver your completed request to:
St. Mary Medical Center
Health Information Management
- Mailing Address: 18300 Highway 18, Apple Valley, CA 92307
- 16071 Kasota Rd., Suite 401, Apple Valley, CA 92307
- Phone: 760-242-2311, ext. 6100
- Fax: 760-946-4219
Hours of Operation: Mon-Fri: 8 a.m.-4:30 p.m.
- When picking up your copies you will be required to show photo identification.
- Please note it takes approximately 10 to 15 working days to process a request.
Medical records may be released to anyone that the patient authorizes in writing to receive such information. A valid authorization MUST contain the following information:
- Patient’s full name (including any former name)
- Patient’s date of birth
- Specific information to be released (i.e. lab report, imaging report) and date of service
- Purpose for which the information may be disclosed (continuing care, insurance, personal use)
- To whom the information is to be sent to including name and address or who will pick up the information
- Expiration date when the authorization is no longer valid
- Identify if you would like a copy of the authorization
- The patient’s signature or a patient’s legal representative’s signature. Authorizations signed by a representative must include a copy of the durable power of attorney, guardianship, etc.
- Date of signature
Information pertaining to mental health treatment, HIV and alcohol and drug use are designated as sensitive information. In order to release this information, the authorization must specifically state this. There are check boxes on the authorization that should be checked and initialed if this information is requested.
There may be a fee associated with the production of your medical records. St. Mary Medical Center utilizes BACTES Imaging Solutions. If you have questions regarding the fee, please contact BACTES at 714- 882-5886.
If you have any questions regarding obtaining copies of your medical records, please contact Health Information Management at 760-242-2311, ext. 6100