Medical Records
How to request a copy of your Medical Records
1. As part of the Health Insurance
Portability and Accountability Act (HIPAA) records may be released
without authorization for reasons related to further treatment of the
patient, for payment by insurers, and for operation reasons like
quality studies within our facilities. These records are released only
to the patient, parent, or legal guardian.
2. Medical records requested for reasons other than treatment, payment,
or operations require a signed “Request For Records” and a photo ID
that allows us to validate that the request is authentic.
3. To request a copy of your records please print and complete the
“Request For Records” indicating the dates of treatment for which you
are requesting information. (Two file types of the "Request For
Records" are located in the upper right hand column of this page.)
4. If your records include information about AIDS/HIV, psychiatric
care, or alcohol/drug abuse care you must specifically indicate that
you are authorizing these records to be released by noting this in the
INFORMATION REQUESTED on the “Request for Records.”
5. Items like Radiology Images, Photos, and Telemetry Tapes are not a
part of the medical record. If you need these images contact the
departments directly.
6. Cost of obtaining medical records—10 pages of information is
available to patients each year without charge. Most other requests
will incur a charge. Call the Health Information Management Department
at the numbers listed on the “Request for Records” for additional
information. Fees are waived for information being sent to another
medical care provider.
7. Requests for information to go to another medical facility or physician
office are top priority and completed within the time frame requested.
Please allow two to three weeks for other routine requests to be
processed.
8. Payments for copies must be paid at the time copies are picked up or
when received by mail. We reserve the right to request pre-payment for
copies. Cash, checks, and credit cards are accepted for payment.
9. "Request For Records" forms can be faxed, mailed or brought
to the Health Information Management departments at any of the NAH
facilities. Address information is listed on the bottom of this Web
page.
10. Fax numbers
Flagstaff Medical Center Health Information Management
928 773-2398
Verde Valley Medical Center Health Information Management
928 639-6033
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Download the
"Request For Records" Form |
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Northern Arizona Healthcare - 1200 N. Beaver St., Flagstaff, Ariz.
86001 - 928 779-3366
Flagstaff Medical Center - 1200 N. Beaver St., Flagstaff, Ariz.
86001 - 928 779-3366
Verde Valley Medical Center - 269 S. Candy Lane, Cottonwood, Ariz. 86326 - 928
639-6000
VVMC - Sedona Campus - 3700 W. Highway 89A, Sedona, Ariz., 86336 - 928 204-3000
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