To get a copy of your medical records for yourself or someone else, complete a Release of Information Authorization form. You can download the form or get one from our office or any clinic front reception desk.
How to Request your Record
Release of Information Authorization forms can be dropped off in person at the reception desk on the first floor, or sent to us by mail, fax, or email.
Hours: Monday through Friday, 8 am - 4:30 pm
Phone: (206) 606-1114
Fax: (206) 606-1035
Seattle Cancer Care Alliance
Health Information Management
PO BOX 19023, G7085
Seattle, WA 98109
There is no charge for records sent to you or your doctor. There may be a charge for records sent to insurance companies and other third parties.
Our average turnaround time for each records request is 24 to 48 hours. When required for emergency care, medical records will be sent to outside care providers within eight hours.
Information We Need
To process your request, we need this information on the form:
- The full name and date of birth of the patient
- The phone number of the person making the request
- The full name and address of the person or organization to receive the records
- The specific health care information you would like disclosed
- A brief description of the purpose for the disclosure
- An expiration date after which time you no longer want the request to be valid
Let us know the format you prefer for your medical records:
- Encrypted email (if file is not too large)
If you have prearranged to pick up your records in person, please be prepared to show a valid photo ID. If someone else will be picking up your records for you, we will need their name in advance and they should be prepared to show a valid photo ID.