This form is used to release patient medical information to the patient, parent, or a third party. To request your patient medical record:
- Download and complete the Medical Records Release of Information Form
- Print and sign the completed form
- Fax the form to (509) 473-6042
Fee schedule for electronic request of personal health information:
| Item: | Price: |
| Labor Charge Small (0-100 pages) | $9.28 |
| Labor Charge Large (100+ pages) | $18.56 |
| Encrypted USB Drive | $29.69 |
| Expedition Charge | $10.00 |
| Certification Charge | $20.00 |
| Postage Due (current rate) | $1.24 |
| Fed Ex Overnight Express | Rate varies upon destination |