Northern Arizona Healthcare has partnered with Sharecare to fulfill your records requests.
Northern Arizona Healthcare is committed to protecting your medical information. For information about your rights and the obligations you have regarding the use and disclosure of your medical information, please see our Notice of Privacy Practices.
If you are our patient and would like to request your medical records, please click on the link below to complete your request. To submit electronically, you must provide a valid email address and a government-issued ID.
How to submit
- Patient Online Access Form – This is exclusively for patients and legal guardians with legal paperwork requesting a copy of their medical records.
- Requester Submission Portal – This option is for health care providers, attorneys, or anyone requesting the medical records of someone other than themselves and who is not the legal guardian.
- If you cannot complete the electronic form above, download and complete the paper form below and fax to 866-381-5303. The authorization form must be legible and complete. Authorizations that are illegible or incomplete will be returned. Please note the processing of records is faster using the online form above. Please see forms below.
- Use this form to request the medical records in English
Authorization to Use or Disclose Protected Health Information English - Use this form to request the medical records in Spanish
Authorization to Use or Disclose Protected Health Information Spanish - Mail in request to:
- Health Information Management – Flagstaff Medical Center
Medical Record Requests
1200 N. Beaver St. Flagstaff, AZ 86001
- Health Information Management – Flagstaff Medical Center
- Use this form to request the medical records in English
FAQ
How do I check the status of my request?
How do I pay for my records and/or radiology images?
How do I contact customer service?
Please call 978-922-0016
When will my request be processed?
Records are usually available within 10 days from the time the request is received. If you are picking up your medical records in person, please be sure to bring a government-issued ID. To arrange for another person to pick up the records for you, please indicate that on the authorization form, and ask them to bring their government-issued ID.
Who can pick up the records?
Only the patient, parent/legal guardian, or the patient’s legal health care representative can sign the form to release medical records. If you are requesting records on behalf of the patient or as the patient’s representative, please provide a copy of an Advance Directive/Durable Power of Attorney for healthcare conservatorship.
Where do I pick up my records?
Flagstaff Medical Center at Northern Arizona Healthcare
Health Information Management kiosk
1200 N. Beaver St.
Flagstaff, AZ 86001
Phone: 928-773-2072
Fax: 928-773-2178
Email: [email protected]
Verde Valley Medical Center at Northern Arizona Healthcare
Health Information Management
Medical Record Requests
269 S. Candy Lane
Cottonwood, AZ 86326
Phone: 928-639-6280
Fax: 928-639-6030
Email: [email protected]