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.
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
Seattle Cancer Care Alliance
Health Information Management
PO BOX 19023, G7085
Seattle, WA 98109
SCCA Issaquah
SCCA Issaquah
Medical Records
1740 NW Maple St., Suite 211
Issaquah, WA 98027
SCCA Peninsula
SCCA Peninsula
Medical Records
19917 Seventh Ave, Suite 100
Poulsbo, WA 98370
SCCA at UWMC-Northwest
SCCA at UWMC-Northwest
Medical Records
1560 115th St. Suite G16
Seattle, WA 98133
SCCA at EvergreenHealth
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.