Medical Records
My Medical Records
Ashley Regional Medical Center respects the privacy rights of each patient. Your medical record contains health information about:
- Yourself
- Results of diagnostic tests and therapeutic procedures performed
- Your medical history, condition, and progress during your hospitalization
- Documentation by all physicians and healthcare providers involved in your care and treatment
- The quality of care you received at Ashley Regional Medical Center
We take precautions to safeguard your health information and ensure only the necessary information gets to the designated individuals as conveniently as possible.
How do I receive the health information from My Medical Record?
The information in your medical record is confidential and protected by the Federal HIPAA Privacy Rule. Therefore, we must receive a completed “Release of Information Authorization Form” and confirm your identity before releasing the medical information to you or your legal personal representative. Only the patient or his/her legal guardian can sign the authorization.
To obtain a free copy of your medical record, you will be asked for the following two (2) items:
- A copy of your Government-issued ID (i.e., Driver’s License, Photo ID).
- The completed/signed Authorization Form.
Submit the above items by one of the following methods:
- Fax to 435-789-6128 (up to 25 pages; please allow 2 business days to receive your information)
- Walk-In to Release of Information in Medical Records or Radiology Department for CDs and Results (Monday-Thursday 9 a.m. to 4 p.m., Friday 9 a.m. to 2 p.m.)
If the information that you are requesting is for your health care provider(s), we recommend the provider(s) fax us a written request directly from their office. Our fax number is 435-789-6128.
Forms
- Release of Information Authorization Form - English
- Release of Information Authorization Form - Spanish
Submit Online
Contact Information
If you have additional questions, please call our Release of Information Specialist at 435-789-3342 Ext. 264. Our fax number is 435-789-6128.