Patients & Caregivers

Medical record request

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 below or get one from our office or any clinic front reception desk.

Request Your Records (PDF)

When to Use This Form (PDF)

How to request your record

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.

In accordance with Washington state law, medical records will be responded to in no more than 15 working days from the receipt of the request, with records needed for emergency care processed in a more stat manner.

SCCA South Lake Union

Hours: Monday through Friday, 8 am — 4:30 pm
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.
fax (206) 606-1035
email release@seattlecca.org
Mail to:
Seattle Cancer Care Alliance
Health Information Management
PO BOX 19023, G7085
Seattle, WA 98109

SCCA Issaquah

Hours: Monday through Friday, 8 am — 5 pm
fax (425) 392-8827
email isqrelease@seattlecca.org
Mail to:
SCCA Issaquah
Medical Records
1740 NW Maple St., Suite 211
Issaquah, WA 98027

SCCA Peninsula

Hours: Monday through Friday, 8 am — 5 pm
fax (360) 598-6227
email pccrelease@seattlecca.org
Mail to:
SCCA Peninsula
Medical Records
19917 Seventh Ave, Suite 100
Poulsbo, WA 98370

SCCA at UWMC-Northwest

Hours: Monday through Friday, 7 am — 4:30 pm
fax (206) 606-6855
email nwhhimfax@seattlecca.org
Mail to:
SCCA at UWMC-Northwest
Medical Records
1560 115th St. Suite G16
Seattle, WA 98133

SCCA at EvergreenHealth

Hours: Monday through Friday, 6:30 am — 5:30 pm
fax (425) 441-2700
email evgrelease@seattlecca.org
Mail to:
SCCA at EvergreenHealth
Medical Records
12040 NE 128th St.
MS 98, Suite 1600
Kirkland, WA 98034

Information we need

To process your request, we need the below information filled out on the Release of Information Authorization 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:

  • Paper
  • Fax
  • Encrypted email (if file is not too large)
  • CD

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.