Medical Records Request

Medical Records Request

If you would like to request a copy of your medical records, please download and complete the form below. You may submit it via this form or send a formal request via mail.

Download the
Records Release Form
Complete a
Chart Amendment Form
Name of Patient(Required)
Patient Date of Birth(Required)
Name of Person Requesting Records (if different from above)
Max. file size: 128 MB.

Send in Your Request via Mail

P.O. Box 1452
Pasco, WA 99301-1223

Phone: (509) 547-2204 Ext. 1933

Fax: (509) 545-3960