Looking to Obtain a Copy of Your Medical Records?

Paper Copy of Medical Records:

Federal HIPAA laws require an authorization to be completed for all medical record requests, unless your provider is requesting them for your care. Your medical record, and the information it contains, is confidential. Therefore, we must confirm your identity before releasing your medical record. Only the patient or his/her legal guardian can sign the form. You can download the authorization form below:

Release of Information Form:


Download Forms


Medical Records Release

English

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Walk-In Hours

Please fill out the Release of Information form by clicking on the links to the form at the top of this page. This same form may also be obtained from the hospital at the Information Desk in the lobby. Please fill out all fields and include a copy of your photo I.D. Turn it back in to the Information Desk in the hospital lobby, or you may forward this form to CIOX Health for processing, by fax, mail, or e-mail.

Nashville Health Information Management
Release of Information HSC Fax: (877) 865-9738
552 Metroplex Drive
Nashville, TN 37211
E-mail: ROIHealthport.NSVSSC@Parallon.com

  1. Authorization for Use and Disclosure of PHI Form Completed and signed
  2. A current government issued photo ID (passport, driver’s license, State ID, or military ID)

Records will be mailed to you unless you selected another method of receipt on the form, such as fax or email. Please note that records prior to 2012 may take slightly longer to process if they must be ordered from off-site storage.


Records for your Physician

Our goal is to get your health information to the appropriate health care provider as quickly as possible; therefore we recommend that your physician (or other healthcare provider) request a copy of your medical records to be delivered directly to his/her office by fax. There is no charge to you for this service.

Lab or Radiology results

The physician who ordered your tests should be able to provide you with results and explain what they mean. However, if you would like to be able to view and print your own lab or radiology results from home, consider signing up for our complimentary MyHealthOne Patient Portal. Access or sign up online or call (855) 422-6625.

Not interested in MyHealthOne Patient Portal?

You may go to the Lab Reception desk during regular business hours to receive a copy of your lab results. Please be prepared to show your I.D. and fill out a request form which will need to be signed by the patient or legal guardian. Lab hours are Mon – Fri 7:00am – 5:00pm.

Radiology CDs

The Radiology Reception Desk will be able to burn a disc for you while you wait. The actual patient should be present and prepared to show his or her I.D. and fill out a request form. Reception Desk hours are Mon – Fri 7:00am – 5:00pm.

Need Records Today?

If you have an urgent need to get copies of records today, you may visit our centralized walk-in office, located at 520 Medical Drive, Suite 230, Bountiful, Utah. This office can process medical records requests for any Utah MountainStar Hospital and is open Mon – Fri from 8:30am – 5:00pm. Their phone number is (801) 212-5818. Please arrive to allow adequate time for processing records while you wait.*

* Note: The majority of items, such as labs, radiology, operative reports, ER reports, and discharge summaries will be available immediately. Some portions of the record prior to 2012 may be handwritten and may require the record to be ordered from off-site storage, thus causing a need for additional processing time. Your patience is appreciated.

Contact Information

If you have additional questions, you may call our Release of Information specialists at (801) 479-2061, extension 1, or (866) 270-2311.

Read more about our responsibilities and your rights for privacy.