If you would like to receive a full
copy of your health records, please fill out the Authorization to Release Protected Health Information
The authorization form must be signed and notarized. Make sure to include your name, date of birth, address, telephone number and date of record request on the consent form to assure locating your records. Please indicate if the records are to be mailed to you or another person of your choice. If it is your physician, please provide their full mailing address or fax number.
You may fax or e-mail this consent form back to Yuma Regional Medical Center.
Release of Information
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, by faxing 928-336-7154 or via e-mail to 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.
If you are in need of personal assistance, please call 928-336-7017
Obtaining a Birth Certificate
Yuma Regional Medical Center does not have access to state birth records. To obtain a certified copy of a birth certificate for a child born in Arizona, contact:
Office of Vital Records
Arizona Department of Health Services
P.O. Box 3887
Phoenix, AZ 85030