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Sponsorship Request Application
Patients must request their records in writing. The Medical Records Department will verify your identity by photo I.D., signature, or pertinent questions. We do this to protect the privacy and confidentiality of your records.
Our department has 30 days to respond to your request and make your records available to you.
Patient or Power of Attorney Request for Access to Protected Health Information
Third Party Request Authorization for Use or Disclosure of Protected Health Information
AUTORIZACIÓN PARA EL USO O DIVULGACIÓN DE INFORMACIÓN PROTEGIDA DE SALUD PARA MERCADOTECNIA Y / O DAR A CONOCER A LOS MEDIOS DE COMUNICACIÓN
Medical Records Contacts and Hours of Operation:
Chandler Regional Medical Center | 480.728.3980
Mailing address: 1955 W. Frye Rd., Chandler, AZ 85224
Mercy Gilbert Medical Center | 480.728.7130
Monday through Friday from 8 a.m. to 5 p.m.
Completed authorization forms can be faxed to 480.728.9618
Mailing address: 3555 S. Mercy Rd., Gilbert, AZ 85297
St. Joseph's Hospital and Medical Center | 602.406.3350
Monday through Friday, from 8 a.m. to 4:30 p.m.
Completed authorization forms can be faxed to 602.406.4120
Mailing address: 350 West Thomas Rd., Phoenix, AZ 85013