Request Medical Records

At The Hospitals of Providence, it’s not only our job to keep you healthy.  We’re also focused on keeping your healthcare information private as well.

If you’d like a copy of your medical records, please print out and complete the appropriate Authorization to Use and Disclose Health Information below.

East Campus Disclosure Authorization
East Campus Formato de Autorizacion para Compartir Informacion Medica Personal Protegida
Memorial Campus Disclosure Authorization
Memorial Campus Formato de Autorizacion para Compartir Informacion Medica Personal Protegida
Sierra Campus Disclosure Authorization
Sierra Campus Formato de Autorizacion para Compartir Informacion Medica Personal Protegida

Bring this completed form as well as a photo ID when you come to pick up your records.

If someone else will be picking up your medical records, that person needs a photo ID and a signed authorization letter from you. 

Health Information Management Office Phone Numbers

Memorial Campus: 915-577-6681

Sierra Campus:  915-747-2681

East Campus: 915-832-2761