Medical Records

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Authorization to Release Patient Information

IMPORTANT: Please be aware that not all personal emails are secured. For this reason, due to Federal HIPAA* regulations please do not include personal health information in any email correspondence.

To Request Copies of Your Records from Another Doctor be Sent to Pacific Medical Centers

Please coordinate with your PacMed doctor regarding which of your former records are desired. Then, contact your former doctor or clinic to coordinate the request for the release of information directly through that clinic or doctor.

To Request Copies of Your Pacific Medical Centers Record for Your Personal Use

Please fill out this form:

Authorization to Release Patient Information to Self

Please fax your completed form to (206) 621-4235, or mail your form to:

HIM ROI Dept.

1200 12th Ave S

Seattle, WA 98144

There will be a fee associated with this request.

To Request Copies of Your Pacific Medical Centers Record be Sent to a Third Party

Please fill out this form:

Authorization to Release Patient Information to a Third Party

Please fax your completed form to (206) 621-4235, or mail your form to:

HIM ROI Dept.

1200 12th Ave S

Seattle, WA 98144

No fee charged.

If you have any other questions or concerns, you can contact us at (206) 621-4150 or write us at the address above. Please include your name, a contact number, the dates you were seen (as best as you are able) and your date of birth.

*Health Insurance Portability and Accountability Act (HIPAA) protects the security and privacy of health data.