Arrowhead regional medical center medical records 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Patient Information. Fill in your name, Social Security Number (SSN), Medical Record Number, and Date of Birth (DOB) accurately.
3. Indicate your preference for receiving information by checking either 'Have the information mailed' or 'Pick-up the requested information'.
4. Authorize disclosure by selecting whether you want to disclose or obtain your protected health information. Provide the name and mailing address of the recipient if disclosing.
5. Select the specific types of health information you wish to disclose by checking all applicable boxes, such as Discharge Summary, Radiology Reports, etc.
6. Specify the Date(s) of Service for which you are requesting information.
7. If applicable, initial next to any highly confidential PHI categories that you authorize for use or disclosure.
8. Finally, sign and date the form at the bottom. Ensure that all fields are completed before submission.

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