Medical Records Request - UC Health 2026

1. Click ‘Get Form’ to open the Medical Records Request - UC Health in our editor.
2. Begin by selecting the UCHealth facility from which you are requesting records. Options include Broomfield Hospital, Memorial Hospital, and others. If your facility is not listed, specify it in the 'Other Facility/Provider' section.
3. Fill in your personal details: Patient name, any former names, birth date, address, and phone number. Ensure accuracy for a smooth processing experience.
4. Indicate the purpose of your request by checking the appropriate box (e.g., Continuation of care, Personal). This helps streamline the processing of your request.
5. Specify where to send the records by filling out the recipient's name/facility and contact information. Include a phone number and fax if applicable.
6. Select the date range for the medical records you need and choose your preferred method of release (Email, My Health Connection, Mail).
7. Check all relevant types of records you wish to obtain. If specialized information is included, ensure you consent by signing where indicated.
8. Finally, sign and date the form at the bottom to authorize the release of your medical records.

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