If after receiving your Health Records you feel there is a discrepancy, on any of the reports, please fill out a Change in the Medical Record form. Complete and return to the Health Records Department in person, or by faxing (928-336-7154) or via e-mail firstname.lastname@example.org .
Please include your name and telephone number on the form in the event we need to contact you. In the space provided please state what you are requesting to be changed and what document(s) the error is on. By signing this form, you are giving us permission to contact the physician of record in regard to your request. Please allow 3-6 weeks for your request to be completely processed.