Request Medical Records

Step 1: Download and Fill Out the Form

We are happy to help you request copies of health records. To successfully request health records, you must download and properly complete an authorization form. After we receive your completed form, we can release your medical records.

Download Authorization Release Form (English)

Download Authorization Release Form (Spanish)

Autorización para el uso o divulgación de información médica protegida (PHI)

*The document is available as a printable (PDF) file using Adobe Acrobat. If you do not already have an Adobe Acrobat Reader, download a free copy now.

Step 2: Make Sure Your Form is Correct

To expedite your request, we assembled these tips to help you properly complete your form.

Make sure your form:

  • Is properly addressed to the facility being asked to release the information.
  • Has the address of the facility or person receiving the information.

Be sure your form has the patient’s:

  • Full name, including previously used names.
  • Address.
  • Date of birth.
  • Social Security number.

Additional necessary information:

  • The information and date(s) of service you want released.
  • How much information: Pertinent records may include a discharge summary, history and physical, test results, an emergency department report, and any consultations; all records include all vitals and large amounts of routine documentation.
  • The reason you want the information released.
  • Instructions on whether you want to pick-up the information or the appropriate mailing information.
  • The date of your request.
  • The patient’s signature.

If the patient is unable to sign the request form due to a physical or mental disability, a guardian or court-named personal representative may sign for the patient. If the patient has no guardian or personal representative, the individual with medical power of attorney may sign for the patient. You must provide appropriate legal documentation with the request form if the patient is unable to provide their own signature.

We regret that we cannot accept digital signatures.

What You Can Request

While we can provide medical information and records, we cannot provide copies of birth certificates. For a copy of a birth certificate, please contact the Colorado Department of Public Health and Environment at 303-692-2200.

Step 3: Submit Your Request Form

You can send your request to us through fax, mail, email, or in person. If you email the form, it must be attached as a scanned document.


Mailing Address:
Platte Valley Medical Center
Attn: Health Information Department
1600 Prairie Center Parkway
Brighton, CO 80601


Hours of Operation:
M-F; 8 a.m. to 5 p.m.

Please contact us if you have any additional questions or need further assistance.

Additional Information

We will fulfill your medical records request within 7-10 business days, and we will inform you if we experience an unexpected delay.

We may apply fees or charges in accordance with SCL Health policies, but we will notify you of any applicable fees before we process your request.

For additional questions, please call 303-498-1679 or email EH-CROI@sclhealth.org.

Our Health Information Management department (HIM) is located on the third floor of the medical office building, Medical Plaza 1, Suite 330, and is open Monday through Friday, 8 a.m. to 5 p.m.

How do I request copies of my medical records?

You can request copies of your medical records in one of the following ways:

  1. Print and fax or mail the release of information authorization form (below). Make sure your form is completely filled out and the information you provide is correct.
    1. Fax to HIM Department, 303-498-1677
    2. Mail to HIM Department, 1600 Prairie Center Parkway, Brighton, CO 80601
  2. The person who signs the release must include a copy of their picture ID and a contact telephone number. Records will be mailed back to the requesting party.
  3. Or, you may bring your completed form and a picture ID to the HIM Department in person.

How long does the process take and what does it cost?

If the request is only a few pages, we can generally complete your request while you wait. However, if the record is a larger volume, we will arrange to mail the records to you or have you pick them up. We will fulfill your medical records request within seven to 10 business days, and will inform you if there is a delay. We may apply fees or charges in accordance with SCL Health policies, but we will notify you of any fees before we process your request. If you have any questions or need further help, contact us at 303-498-1640.

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