Medical Records

Mammoth Hospital keeps records of the services we provide for you. We do not disclose your record to others unless you give us permission or the law authorizes us to do so.

Requesting your Medical Records

To request your Medical Records, please either complete the form online or print and complete the Authorization to Disclose Health Information form located in the English Forms section below.

Forms and Medical Records may also be picked up at our Medical Records Office.

English Forms

• Authorization to Disclose Health Information
• Request for Limitations & Restrictions of Protected Health Information Form
• Request for Correction/Amendment of Health Information Form
• Statement of Disagreement to Include Amendment Request and Denial with Future Disclosures
• Request for Restriction on the Manner/Method of Confidential Communications Form
• Request for Accounting of Disclosure Form
• Patient Rights
• Notice of Privacy Practices

Spanish Forms

• Autorización para proporcionar información médica
• Solicitud De Limitaciones Y Restricciones De La Información Protegida Concerniente A La Salud
• Solicitud de corrección o enmienda de información concerniente a la salud
• Declaracion de Desacuerdo/Solicitud de Incluir la Enmienda Y El Rechazo Con Futuras Divulgaciones
• Solicitud De Restricción En La Forma O En El Método De Envío De Comunicaciones Confidenciales
• Solicitud Del Estado De Cuenta De Revelaciones De Informacion Protegida De Su Salud
• Informe de Normas de Confidencialidad