You request records by completing the Patient Care Report Release Form / Formulario de divulgación del informe de atención al paciente – Español. If you are requesting a record and you are not the patient, you must provide the applicable “Required Documentation” (below), or complete the Notarization page attached to the Patient Care Report Release Form. We ask that a valid photo ID be included with all requests.
- Required documentation for request based on requestor:
- Spouse – Healthcare Power of Attorney or Court-issued Letters of Administration & Death Certificate (if available) or This Form Notarized
- Parent of Minor Child –Birth Certificate or This Form Notarized
- Guardian – Court-issued Guardianship Papers or This Form Notarized
- Executor/Administrator/Attorney in Fact – Court-issued Letters of Administration & Death Certificate (if available) or This Form Notarized
- Patient’s Healthcare Power of Attorney – Copy of Healthcare Power of Attorney
