Northern Arizona Healthcare is committed to protecting your medical information. For information about your rights and obligations regarding the use and disclosure of your medical information, please see our Notice of Privacy Practices.
Please follow the instructions below to request medical records for yourself or someone else. To request these records electronically, you must have a valid email address and a government-issued ID.
How to submit
Medical record requests require a signed “Authorization to Disclose Protected Health Information” form and a photo ID. 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 to send information to another health care 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 the medical records in English
Authorization to Use or Disclose Protected Health Information English
Use this form to request the medical records in Spanish
Authorization to Use or Disclose Protected Health Information Spanish
Requesting records
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:
Flagstaff Medical Center at Northern Arizona Healthcare
Health Information Management kiosk
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:
Verde Valley Medical Center at Northern Arizona Healthcare
Health Information Management
Medical Record Requests
269 S. Candy Lane
Cottonwood, AZ 86326
Phone: 928-639-6280
Fax: 928-639-6030
Email: [email protected]
FAQ
When will my request be processed?
- Records are usually available within 10 days from the time the request is received. If you are picking up your medical records in person, please be sure to bring a government-issued ID.
- If another person will pick up the records for you, please indicate who that will be on the authorization form. They will need to present their government-issued ID.
Who can pick up the records?
Only the patient, parent/legal guardian, or the patient’s legal health care representative can request medical records. If you are requesting records on behalf of a patient or as a patient’s representative, please provide a copy of an Advance Directive/Durable Power of Attorney for Healthcare Conservatorship.
Where do I pick up my records?
Flagstaff Medical Center at Northern Arizona Healthcare
Health Information Management kiosk
1200 N. Beaver St.
Flagstaff, AZ 86001
Phone: 928-773-2072
Fax: 928-773-2178
Email: [email protected]
Verde Valley Medical Center at Northern Arizona Healthcare
Health Information Management
Medical Record Requests
269 S. Candy Lane
Cottonwood, AZ 86326
Phone: 928-639-6280
Fax: 928-639-6030
Email: [email protected]