Medical Record Request
For an Island Hospital medical record request, please follow the instructions below:
1. Print an Authorization to Disclose/Obtain Protected Health Information (PHI) form.
2. Mail or fax the completed form to:
Medical Records Department
PLEASE NOTE: We are unable to accept forms with electronic signatures or forms sent as an attachment to an email.
Here is what is required on the form.
To be valid, the Authorization to Disclose/Obtain Protected Health Information form needs to be in writing, dated, signed BY THE PATIENT, and must contain the following information:
- From whom the information is to be released (Island Hospital).
- To whom the information is to be released.
- The purpose of the release (box needs to be checked - usually personal).
- What information the patient is requesting needs to be noted.
- The time period when the service was performed. If you can't remember exactly, providing a general time frame gives us a hint (example: July 2018).
- Contain an expiration date (example: one week from today).
- Be signed and dated by the patient.
Spouses generally CANNOT sign for each other. There are, of course, circumstances involving guardianship, minors, Durable Power of Attorney for Health Care (which is only applicable if the patient is unable to sign for themselves), etc. The age requirements for diagnoses involving mental health, alcoholism, drug abuse, pregnancy/pregnancy termination, sterilization, or sexually transmitted disease including HIV/AIDS, are listed on the form.
Island Hospital does not charge patients for copies of "pertinent" information, such as the History and Physical, Discharge Summary, Operative Report, laboratory results, or x-ray reports. If you are requesting a complete copy (i.e., every page of your chart), we will count the pages and send you a bill for prepayment. According to the Washington Administrative Code (WAC 246-08-400), hospitals may charge $1.12 for the first 30 pages and $0.84 for additional pages. This number includes Washington State sales tax of 8.5%.
If you have questions, please call Island Hospital Medical Records at (360) 299-1326.
Understanding Medical Record Codes
Your medical record has universal codes that apply to your conditions. To understand what these codes signify, click here.