Healdsburg Hospital
Release of Patient Information
Providence St. Joseph Health (PSJH) is required by law to maintain the privacy of your health information, to provide you with a notice of our legal duties and privacy practices, and to follow the information practices that are described in the Notice of Privacy Practices.
You have the right to receive a copy of your health information that we maintain, with some limited exceptions. You have the right to receive a copy of your health information in one of the following formats: MyChart Patient Portal, email, fax, CD via mail, or paper via mail. You have the right to request that your health information be sent to any person or entity.
Medical records are maintained by the hospital for the time period required by state law, and some medical records may not be available.
Patient information processed outside of Health Information Management (HIM) Medical Records: Please contact the department directly at the facility in which you were treated. Example: Radiology, Provider Office/Clinic, Pathology, etc. Be advised, separate authorization required.
Hospital or Provider/Clinic Itemized Billing or Financial Documents: Call Regional Business Office: 1-866-747-2455. You may also visit the Providence St. Joseph Health Online Bill Pay and Financial Assistance website.
Processing time for copies of medical records with valid authorization
Please allow sufficient time for processing of a medical record request. Turnaround time varies according to request type and state law:
- California: up to 15 business days
Fees for copies of medical records
Continuation of care: Medical records sent directly to providers or other healthcare facilities: No Fee
Patient/patient representative: A reasonable fee may be charged based on volume of medical records requested. The fees are based on State and Federal Regulations
Other requester types: Fees are based on State and Federal Regulations
Payment for copies of medical records
Follow the payment instructions on the medical records invoice you receive. Payments for medical records may be made via check, money order or credit card. Cash is not accepted. Some locations also have an option to pay online using the information on the medical records invoice.
How To Obtain a Copy of Medical Records
Option 1: MyChart (patient portal)
MyChart secure patient portal allows patients to view portions of their medical record, and request copies of medical records that are not available through MyChart. There are no fees associated with accessing medical records via MyChart.
Most documents will auto-populate to your MyChart account within 24 hrs from time of visit.
- Clinical notes are shared immediately to the patient’s MyChart when signed by the authorizing provider.
- Test results are released hourly after they have been finalized. If not available, please contact the ordering provider.
- Other documents may be shared immediately when filed to the patient’s medical record.
If you already have a MyChart account, please login.
Option 2: Patient request to access/disclose a designated record set (DRS) form or written document
To receive a copy of your medical records, you may complete the form or write a letter.
If you choose to write a letter, it must include the following required elements:
- Signed by the individual (patient) or patient representative
- Clearly identify the patient, preferably name and date of birth
- Clearly identify the intended recipient including name and address designated to receive the records
- Specify the date range, specific medical records, and name of facility where treatment was received
If you choose to use the form, please complete all sections with special attention to the following:
- Indicate the dates of treatment/admissions for which you are requesting information
- Indicate the type of records needed, e.g. Lab results, imaging report, Discharge Summary
- Release of HIV test results, Mental Health treatment or Alcohol/Drug treatment require initials and date next to the requested information
Patient Request to Access/Disclose a Designated Record Set Form for Release of Health Information
Note: Please download the above PDFs to enable online submission.
Important notice
Incomplete requests are considered invalid and will be returned for additional information.
Patient representatives may need to provide supporting documentation to fulfill the medical records request e.g. Durable Power of Attorney, Advance Directive, guardianship or conservator forms.
How To Submit Your Medical Records Request
We're asking for your help to reduce the amount of paper requests we receive. HIM-ROI is not onsite. Please submit your request via email or fax. Thank you.
For hospital records:
Healdsburg Hospital
1375 University Avenue
Healdsburg, CA 95448
Phone: 707-431-6470
Fax: 1-855-234-2493
Send an email
Hours of operation: Mon - Fri, 8:30 a.m. - 4 p.m. Closed weekends and Holidays.
For Provider Office/Clinic records: Please visit Medical Groups | Services | Providence and select the providers location
Patient request access to inspect
PSJH shall permit an individual to request access to inspect their medical record that is maintained in a designated record set. PSJH requires individuals to submit a written request for access to inspect. Please follow instructions from option 1 above to submit a request.
Once the request to access has been received, you will be contacted by a PSJH caregiver to schedule an appointment.
Additional HIM/ROI Information and Forms
Amendment request
You may write a letter or complete this form to request a correction to your protected health information that was originated or created by a PSJH provider.
Accounting of Disclosures request
You may write a letter or complete this form to request an accounting of disclosures of your protected health information by PSJH.
Restriction, revocation or opt out of care everywhere request
You may write a letter or complete this form to restrict the release of your protected health information, revoke a previously signed authorization, or to opt out of Care Everywhere.
Language services
PSJH provides interpreter services for all non-English-speaking patients and patient representatives. Providence Notice of Nondiscrimination and Communication Assistance.