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Yuma Regional Medical Center
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Health Records Release of Information

You may obtain full copies of your health records at Yuma Regional Corporate Center, 399 W. 32nd St.

If you would like to receive a copy of your Health Records, please fill out the Authorization to Release Protected Health Information. The authorization form must be notarized.

Please make sure your name, date of birth, address, telephone number and date of record request are on the consent form to assure locating your records.

Please specify if the records are to be mailed to you or another person of your choice. If it is your physician, please provide the mailing address or fax number.

Please sign the consent form for identification purposes.

You may fax or e-mail this consent form back to Yuma Regional Medical Center.

Fax: 928-336-7154
Attn: Release of Information

If you are in need of personal assistance, please call 928-336-7017.

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