If you would like to receive a copy of your Health Records, please fill out the Authorization to Release Protected Health Information.
Please make sure the necessary information is on the consent form to assure locating your records. This would include:
Name, Date of Birth, Address, Telephone Number, Date of Service that you are requesting.
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.
If you are in need of personal assistance, please call 928-336-7345.