Medical record requests require a signed “Authorization to Disclose Protected Health Information” form and a photo I.D. This enables us to validate that the request is authentic. On this form, be sure to list the appropriate service dates, and check all the specific records you require.
If your records include information about AIDS/HIV, psychiatric care or alcohol/drug abuse care, you must specifically indicate you are authorizing these records to be released by noting this in the “Authorization to disclose information” section of the form.
Note that requests for sending information to another healthcare provider are our top priority. Please allow two to three weeks for routine requests to be processed.
“Authorization to Disclose Protected Health Information” forms can be faxed, mailed or brought to the Health Information Management departments at any of the NAH facilities listed below.
- Use this form to request your medical records in English
Authorization to Use or Disclose Protected Health Information English - Use this form to request your medical records in Spanish
Authorization to Use or Disclose Protected Health Information Spanish
Medical record requests in Flagstaff
To request your medical records from Flagstaff Medical Center and/or Northern Arizona Healthcare Medical Group locations in Flagstaff, please submit a completed authorization form to:
Health Information Management – Flagstaff Medical Center
Medical Record Requests
1200 N. Beaver St.
Flagstaff, AZ 86001
Phone: 928-773-2072
Fax: 928-773-2178
Email: [email protected]
Medical record requests in the Verde Valley
To request your medical records from Verde Valley Medical Center and/or Northern Arizona Healthcare Medical Group locations in Cottonwood, Camp Verde, Sedona and Village of Oak Creek, please submit a completed authorization form to:
Health Information Management – Verde Valley Medical Center
Medical Record Requests
269 S. Candy Lane
Cottonwood, AZ 86326
Phone: 928-639-6280
Fax: 928-639-6030
Email: [email protected]