MEDICAL RECORDS AND BILLING INFORMATION

To receive copies of your medical record, you must complete an Authorization form.

You can download, print and complete this Authorization to Release Health Information form here.

Mail or fax your completed Authorization form to:

SJE
St. Joseph’s Hospital
2700 Dolbeer St.
Eureka, CA. 95501
Dept Phone (707) 445-8121 x7510
Dept Fax (707) 269-3896

RMH
Redwood Memorial Hospital
3300 Renner Dr.
Fortuna, CA. 95540
Dept Phone (707) 725-3361 x4701
Dept Fax (707) 725-7248

The Authorization form must be completed in order to be a valid Authorization.

Information pertaining to mental health treatment, HIV and alcohol and drug are designated as sensitive information. In order to release this information, the Authorization form must specifically state this. There are check boxes on the form that need to be checked if this information is requested.

When picking up your copies you will be required to show photo identification.

(There may be a fee associated with the production of your medical records.)

If you have any questions regarding obtaining copies of medical records, please contact the Health Information Management (HIM) department at (707) 445-8121 x 7510 for St. Joseph Hospital, Eureka, CA or (707) 725-3361 x4701.

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