Intermountain Healthcare understands the importance and sensitivity of your health information. We also understand the importance of giving you easy access to your medical records and keeping those records private.
1. A valid and complete Authorization for Release of Health Information Form signed and dated by the patient is required to request medical records. If needed, download and complete the Authorization for Release of Health Information Form.
For specific records, provide the name, address, and phone number of the facility or provider on the authorization form by referring to the links on the right. Otherwise, you may use ‘Intermountain Healthcare’.
2. Return the completed form with one of the following options:
If you have any questions or issues regarding the medical records release of information process, please contact the Medical Records Request Line using the phone number listed to the right.
Fill out this form to authorize the release of your health information.
Learn about how we safeguard your privacy.
Find information about your responsibilities as a patient.
Find the physical address or fax number of the Medical Records Department that you need to contact to request your medical records.
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If this is an emergency please go to the nearest emergency room or call 911.
Intermountain Healthcare is a Utah-based, not-for-profit system of 33 hospitals (includes "virtual" hospital), a Medical Group with more than 3,800 physicians and advanced practice clinicians at about 385 clinics, a health plans division called SelectHealth, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery.
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