Medical Records

How to submit a request for medical records at Northern Arizona Healthcare

Medical record requests require a signed “Authorization to Disclose Protected Health Information” form and a photo I.D. This enables us to validate that the request is authentic. On this form, be sure to list the appropriate service dates, and check all the specific records you require. 

If your records include information about AIDS/HIV, psychiatric care or alcohol/drug abuse care, you must specifically indicate you are authorizing these records to be released by noting this in the “Authorization to disclose information” section of the form. 

Note that requests for sending information to another healthcare provider are our top priority. Please allow two to three weeks for routine requests to be processed.

“Authorization to Disclose Protected Health Information” forms can be faxed, mailed or brought to the Health Information Management departments at any of the NAH facilities listed below.

Contact Information

Health Information Management – Flagstaff Medical Center
Medical Record Requests 
1200 N. Beaver St.
Flagstaff, AZ 86001

Phone: 928-773-2072
Fax: 928-773-2178
Email: [email protected]

Health Information Management – Verde Valley Medical Center

Medical Record Requests 
269 S. Candy Lane
Cottonwood, AZ 86326

Phone: 928-639-6280
Fax: 928-639-6030
Email: [email protected]