Medical Records Authorization: PMG Clinics - Spokane and Spokane Valley

Please submit your forms by email or fax

We're asking for your help to reduce the amount of paper requests we receive. Please refrain from submitting your forms by mail. Instead, please send by email or fax them to 509-598-2109.

Please note: We do not accept email requests without the Authorization for Disclosure form filled out completely and attached.

Thank you.

Providence 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 a format you prefer (e.g., paper, email, CD, fax, MyChart). You have the right to request that your health information be sent to any person or entity.

Obtain your medical records via MyChart

Patients can obtain copies of electronically-maintained records at no charge directly from your MyChart account. The MyChart secure web portal allows patients to view portions of their medical record, send a message to their care team, view and pay bills, and request copies of medical records.

To sign up for a MyChart account, visit MyChart.

Authorization to disclose information

To receive a copy of your health information, please complete the Authorization for Disclosure form.

How to submit your request for clinic records

Note: Secure building/No Walk-Ins

Providence Medical Group
Attn: Release of Information
24021 E Mission Ave
1st Floor
Liberty Lake, WA 99019

ROI phone: 509-944-9020
ROI fax: 509-598-2109
Send us an email

Processing time

Requests are processed in the date of order received, please allow up to 15 business days for processing. If records are needed for a medical appointment sooner, please indicate that on your request.

Cost

For medical use, there is no fee if records are to be sent directly to a doctor or other healthcare provider for the purpose of continuing care.

For copies for patients or their representatives, there may be a reasonable, cost-based fee.

For copies for other uses, the current rates set by state law may apply.

Payment

Online payment portal 
(To avoid delay, please enter the full invoice amount in the online portal)

For clinic records requests, please mail payment to:

Providence Medical Group
Attn: Release of Information
24021 E Mission Ave
1st Floor
Liberty Lake, WA 99019

Call to make payment over the phone (we accept all major credit creds):

ROI phone: 509-944-9020 

Amendment request

Patient Request to Amend a Designated Record Set form

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 Providence physician.

Language services

Providence provides free language services to people whose primary language is not English.