MHO Release of Information Request 2025

1. Click ‘Get Form’ to open the MHO Release of Information Request in our editor.
2. Begin by filling in your Medical Record Number (MRN) and Date of Birth (DOB) at the top of the form. This information is essential for identifying your records.
3. Select your Sutter Affiliate or Hospital from the provided options. If your provider is not listed, write their name in the designated space.
4. In the Requester Information section, print your name clearly, along with today’s date and your Date of Birth in MM/DD/YYYY format.
5. Provide your email address, mailing address, and phone number. Ensure all details are accurate to avoid delays.
6. Sign and date the form at the bottom. A missing signature will delay processing, so double-check this step.
7. Once completed, you can either bring this form to your next medical appointment or fax/mail it to the Patient Services Contact Center as instructed.

Start using our platform today to easily fill out and manage your MHO Release of Information Request for free!