Records delivered by mail will be shipped within 5-7 Business days after processing. Free, convenient online check-in services. If you wish to hand deliver or mail your request form, please use the following address: NCH Healthcare System 1100 Immokalee Road, Suite 100, Naples, Fl 34110 Hours of Operation: Monday-Friday 8:00 a.m.-4:30 p.m. - Fax - 239-624-6561 - Email - ReleaseofInformation@nchmd.org We will be happy to mail an Imaging CD back to you in a secure CD mailer. Address: 4301 West Markham Street, Slot 524, Little Rock . Valparaiso, IN 46383. (281) 440-1000 Website Patient Portal Order Your Records Get a ride 3 MIN AWAY $8-10 on UberX Get a ride Lyft in 4min $8-10 Health Insurance Northwest Medical Center Medical Records northwest.roi@northwestmedicalcenter.com Phone - (520) 469-8950 Fax - (520) 469-8151 Mail - 6200 N. La Cholla Blvd Tucson, AZ, 85741 Oro Valley Hospital Medical Records orovalley.roi@orovalleyhospital.com Phone - (520) 901-3560 Fax - (520) 901-3984 Mail - 1551 E. Tangerine Road Oro Valley, AZ, 85755 Bentonville, AR 72712 Please ensure all values are in a proper format. Request Medical Records. SAMPLE Detroit Medical Center Attn: Medical Records 6071 W. Outer Drive Detroit MI Phone: (479) 571-7056 Amarillo, TX 79106 For more information, please contact the UAMS Release of Information office: Phone: 501-603-1520. 11113 Research Blvd Austin, TX 78759. Fax: (479) 571-7090 239-624-6581 Submit Forms: Forms can be submitted via mail, fax or email. 710 Cypress Creek ParkwayHouston, TX 77090, Please fill in a valid value for all required fields. Ask at the front desk to be directed to the HIM Department. to keeping your family healthy! Hospitals MD Northwest Hospital Center Get a ride 3 MIN AWAY $8-10 on UberX Get a ride Lyft in 4min $8-10 (410) 521-5995 Website Patient Portal Order Your Records Emergency? For Medical Records and Bill Pay please go to MyHealth One. Medstar National Rehabilitation Hospital. Please allow 3-5 business days for processing, in addition to mailing time. Use our Find a Doctor tool to find the physician best suited to meet your needs. (e.g., drivers license, military I.D. Please call in advance for office visits. 102 Irving St NW. 814-676-7600. After we receive your request, we will send you an invoice for the cost of the records you requested. Remember: There is no adequate substitution for a personal consultation with your physician. Central Scheduling (520) 901-3600 Administration (520) 901-3549 Emergency Department (520) 901-3500 Human Resources (520) 901-3554 Medical Records (520) 901-3560 Patient Accounts (Cashier) (520) 901-3920 Patient Registration (Admitting) (520) 901-3514 For more information, read our Privacy Policy. 3873 Parkview Drive For help and information, contact UPMC Northwest at one of the phone numbers provided below. Email: records@uams.edu. In order to verify your identification and validate your authorization, we require a legible copy of a valid photo I.D. Post Falls, ID 83854. To keep our patients and visitors informed, our hospital provides contact information for each of our departments from Medical Records to Consult-A-Nurse. Access your medical information on demand. Tucson, AZ 85748 520-543-6100 If you authorize release to your physician and list their clinic address on the authorization form, then we will be happy to mail the CD directly to them. Primary and specialty care now available. MedicalRecordsRequest@nw-health.com, Patient Protections Against Surprise Billing, ColumnFriendlyUrl: The SystemName (classes-events) does not exist or is not a module. Phone (520) 469-8950 Address, Phone Number, and Hours for Northwest Hospital & Medical Center, a Hospital, at North 115th Street, Seattle WA. For general information please call (281) 440-1000 or refer to our phone directory. Featuring a monthly dose of information and inspiration for living well. We will need to thoroughly verify the legitimacy of your form and your identification to complete the records retrieval process. For immediate continuity of care, your healthcare provider can request records. If you have questions, concerns or feedback about the care you received at Abbott Northwestern Hospital, please find the appropriate department phone number and reach out to us. Download, print and complete the authorization form. I need assistance with the CareNotify Patient Portal. Verify & Validate. For all other requests, please submit your feedback in the form below. How do I request a copy of my hospital medical records? Attn: Health Information Management. Northwest Medical Center Houghton 2200 S. Houghton Rd. All rights reserved. To obtain a certified copy of your Birth Certificate please contact your state or local Vital Statistics Office. Are you sure you want to leave this form and resume later? Siloam Springs Regional Hospital - (479) 215-3000. 4301 Greathouse Springs We offer several way to request your medical records depending on the type of information you need and preferred format. Oro Valley, AZ, 85755, Patient Protections Against Surprise Billing, ColumnFriendlyUrl: The SystemName (classes-events) does not exist or is not a module. Provider Profile Details: ">Childbirth Basics Virtual Class (Google Meet), Get and Stay Well for 2023: Make the Most of your Health Insurance Now. 1600 Wallace Blvd. Clinical Medical Records Requests. Please Note: Address the envelope Attn: Medical Records. We will offer a full range of imaging services, including CT, MRI, x-ray, ultrasound, nuclear medicine, EKG, EEG, Echo, and stress testing. Fax the completed form to Memorial Hermann at (713) 778-2577, attention: Request for Protected Health Information. Utilize these Quick Links, the navigation above, or Contact Us to find what you were looking for. Cost for delivery in electronic format (CD/USB/download or portal), If the original patient record is Paper To request a copy of your medical records, including test images (film or CD), download, print, complete and sign the applicable form below. Medical Emergencies will be faxed directly to a physician or medical facility. The Northwest Texas Healthcare System is owned and operated by a subsidiary of Universal Health Services, Inc. (UHS), a King of Prussia, PA-based company, that is one of the largest healthcare management companies in the nation. Northwest Medical Center Medical Records MedicalRecordsRequest@nw-health.com, Willow Creek Womens Hospital Intro; Programme; Participating and guest institutions; Organizers; Photo gallery Dial 911 or go to your nearest emergency room Services Emergency: Emergency Department Orthopedic: Joint Replacement, Spine Surgery Special Care: Intensive Care Unit For assistance, call (866) 463-7272. Our department's notary hours are Monday - Friday from 11 a.m. 1 p.m. You may take the Paternity Affidavit form from your discharge folder to your local bank or library to be notarized and mail the form back to us within 3 days from your discharge from the hospital. Ascension Seton Northwest Hospital in Austin, Texas, is a full-service hospital with 24/7 emergency care. Note that some medical records may only be available through our hospital Medical Records office. Find a Houghton Doc. Tel: (202) 877-1587. Northwest Texas Healthcare System 1501 S. Coulter St. Amarillo, TX 79106 Phone: 806-354-1785 Fax: 806-354-1788 reta.howard@nwths.com Consumer Application Access To Your Health Record Learn more about consumer application access to your health record Find a Doctor Visitors Health Alert Info for Visitors Maps and Directions Contact Us Tucson, AZ, 85741, Oro Valley Hospital Medical Records Are you sure you want to leave this form and resume later? The making of additional copies is prohibited. Siloam Springs, AR 72761 We look forward to hearing from you. Patient Request: Access to Protected Health Information (PHI): English | en Espaol Springdale, AR 72764 Our office is closed on holidays. Serving the health care needs of the northwest Baltimore area Learn More 5401 Old Court Road, Randallstown, MD 21133 Directions > Parking Information > Improving the well-being of the community Northwest Hospital, a nonprofit hospital with 231 beds, has served the northwest Baltimore community for more than 50 years. Indianapolis, IN 46278 Or, complete the Request for Medical Records authorization and fax to 317.802.3257. To schedule an appointment, please call during regular business hours. If this is an emergency, call 9-1-1. Medical Record Request - English. Sign-Up For Updates! 3000 Medical Center Parkway If you have concerns about your care, we would like to hear from you. Our Health Information Management (HIM) Departments (Medical Records) are open for Release of Information Services Monday - Friday from 8 a.m. - 4:30 p.m. (closed for lunch from 1 p.m. - 1:30 p.m.). Willow Creek Women's Hospital - (479) 684-3000. 85 East US Hwy 6. The mailing address for Northwest Hospital is 10349 Wetherburn Rd, , Woodstock, Maryland - 21163-1347 (mailing address contact number - 443-878-4197). Please contact the form owner to correct this issue. You may send your request in the following ways: Fax: (844) 481-0298 Email: Email Requests Mail: PO Box 290789 Nashville , TN 37229-0789 To obtain Radiology Images, please contact the Radiology Department directly. Access Medical Records & Images UW Medicine MyChart is a free, secure and convenient way to access many types of personal health information in your inpatient and outpatient medical records, including test results, medical history, medications, immunizations and more. Northwest Hospital Important Phone Numbers , Randallstown, MD - Improving the well-being of the community Northwest Hospital: Serving the northwest Baltimore community > Visitor & Patient Information > Northwest Hospital Important Phone Numbers Northwest Hospital Important Phone Numbers 5401 Old Court Road, Randallstown, MD 21133 P: (219) 983-8300. Fayetteville, AR 72703 For addresses of our hospitals or other affiliated entities, visit . Northwest Health Physicians' Specialty Hospital - (479) 571-7070. Fax: 253-383-5320 to Pediatrics Northwest P.S. For questions regarding obtaining medical record copies, or to obtain the status of your request call (844) 481-0278. Phone (520) 901-3560 Northwest Hospital in Randallstown, MD is rated high performing in 3 adult procedures and conditions. Urgent requests, records for your physician, Non-patient requests (insurance, attorney, disability and third party requests), Authorization for Release of Medical Information, Authorization for Release of Medical Information Spanish. 2022 Northwest Texas Healthcare System. 603 N. Progress Ave. The information, content and artwork provided by this website is intended for non-commercial use by the reader. See general information as well as hospital-specific contact information below. Contact Us Form View our community locations, directions, and parking information. The authorization form must be signed and dated. MyHealthONE consolidates many common tasks into one secure, easy-to-use online patient portal. Northwest Texas Healthcare System 1501 South Coulter Street Amarillo, TX 79106 806-354-1000 806-354-1122 fax Joint Commission-Accredited Northwest Texas Healthcare System is a Joint Commission-accredited hospital, committed to providing high quality and safe care to our patients. Northwest Medical Center - Bentonville 3000 Medical Center Parkway Bentonville, AR 72712 Phone: (479) 553-4000 Fax: (479) 271-7018 MedicalRecordsRequest@nw-health.com Northwest Medical Center - Springdale 609 W. Maple Ave. Springdale, AR 72764 Phone: (479) 757-4500 Fax: (479) 757-2930 MedicalRecordsRequest@nw-health.com Send the original to UPMC using one of the following 3 methods: Mail the authorization to: UPMC, Release of Information Department 450 Melwood Avenue - Lower Level Pittsburgh, PA 15213 Scan the form and email it to ROIRequest@upmc.edu. Adoption paperwork should be taken to your attorneys office. The reader is permitted to make one copy of the information displayed for his/her own non-commercial use. - ( 479 ) 684-3000 Memorial Hermann Release of information and inspiration for living well east side all Certificate! Cgrn endoscopy Nurse Manager 803-713-6467 Creek Women & # x27 ; s office submitted to Vital records 10! 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