Medical Records Request

Obtaining a copy of your medical record is very simple.

To start the process, simply print out the Authorization Form, complete and sign the form, then fax or mail the form to us.

* Please be sure to complete the form in its entirity and sign. An incomplete or unsigned Authorization Form cannot be processed.

Once received, your request will be processed as soon as possible during business days (excludes weekends and holidays).

Arrangements may be made with Health Information Management Correspondence to pick up your copy, otherwise, your copy will be mailed to you.

We will fax to your doctor’s office or another hospital if it is required for patient care.

There is a 25¢ per page photocopying fee due before copy is released for personal access. An invoice may be mailed prior to the actual records being copied and mailed to you. There is no charge if sent to physicians for health care reasons.

We accept check or money order via mail made out to “VISTA HEALTHCARE, LLC” or in person, you may use cash. We are unable to accept credit card or ATM payments.

» Authorization Form