Medical Records

This form is used to release patient medical information to the patient, parent/guardian or a third party. To request your patient medical record:

  1. Download and complete the Medical Records Release of Information Form
  2. Print and sign the completed form
  3. Please provide a copy of your ID with a signature for verification
  4. If you have any questions, call us at 509-473-6912
  5. If POA or Legal Guardian to said patient, please provide a copy of relevant paperwork
  6. Fax completed form to 509-897-8595


Fee schedule for electronic request of personal health information:

Item:  Price:
Labor Charge Small (0-100 pages) $9.28
Labor Charge Large (100+ pages) $18.56
Encrypted USB Drive $50.07
Expedition Charge $10.00
Certification Charge $2.00
Postage Due (current rate) $3.50 (Can vary based on destination and/or weight) 
Fed Ex Overnight Express Rate varies upon destination