Making Your Request
We are happy to provide you with a copy of your medical record. To request a copy of your medical record, you, or someone you designate, must complete the Release of Information form.
In order to protect your privacy, only the patient, parent/legal guardian, or the patient’s legal representative can sign the form to release medical records. The authorization form must be legible and complete in order for us to process your request. You may also request the form from your nurse or contact the medical records department directly at (970) 585-6312, (970) 585-6313, by email at email@example.com, or fax request to (970) 585-6317.
Request to amend medical records can be completed using this form.
Fees for Medical Records
Fees for printing copies of medical records are determined by the number of pages:
$18.53 for the first ten pages
$0.85 for pages 11-40
$0.57 for pages 41+
Actual postage and electronic media costs if applicable. Copies of records are sent to medical facilities or other physicians at no charge. Please read Authorization to Release Medical Information carefully and initial and sign all appropriate boxes.