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Medical Records

Office Hours: Monday through Friday 8-5

Contact information:

Time frame for receiving records: Record requests are usually filled within 7 days but may take up to 30 days.

Please call 24 hours ahead if you would like to pick up the records.

How to Request Your Medical Records

Record Request

This form is for authorization of:

  • Requesting a copy of your personal medical records for personal use, insurance, other doctor, specialist, Legal or military.
  • Requesting the records of an adult child, your spouse or deceased person. You will need to have power of attorney, or proof of legal guardianship.

Record Request to BMH

This form is for authorization of:

  • Requesting your records from another facility to be sent to Blue Mountain Hospital

Federal HIPAA laws require an authorization to be completed for all medical records. Your medical records, and information are confidential, so you must confirm your identity before releasing your medical record. Only the patient or legal guardian can sign the form.

Prior to receiving copies of records or authorizing records to be disclosed, you will be asked to complete the appropriate form and provide proof of your identification with a valid, government issued photo ID (passport, Driver’s License, state or military ID). If requesting for another person you will need to provide power of attorney or proof of legal guardianship.

The appropriate form, along with needed your proof of identification, may be faxed to 435-678-4785.

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