Medical Records

Patient Online Access Form

This is exclusively for patients and legal guardians with legal paperwork requesting a copy of their medical records.
https://myplatform.hds.sharecare.com/submission-tools/ui/patient?clientId=WY300

Requester Submission Portal

This option is for healthcare providers, attorneys or if you are requesting the medical records of someone other than yourself and are not the legal guardian.
https://myplatform.hds.sharecare.com/submission-tools/ui/pro?clientId=WY300

Release of Medical Information Form

Download the Release of Medical Information form here.

Please fill out all highlighted sections, including:

1. Patient’s Name, Date of Birth, Address and Phone Number
2. Facility Authorized to Release Information to:
   • Records Released to you – write in “SELF”
   • Records Released to another Provider or Facility – please fill in the Providers name, address, phone and FAX number.
   • Health Information to be disclosed – include all dates of service, what type of records you want released (labs, x-ray, complete, etc.), why you need the information (treatment, insurance, personal),
3. The Yes/No question is an authorization to release any sensitive information. Typically this should be marked yes if you require all of your information to be released.
4. Patient’s or Authorized Personal Representative’s Signature – please sign, date and time.
5. Leave the Witness Signature line and everything below it blank.You will also need to include a legible copy of  your driver’s license or your Official ID so we may verify your signature with your hospital record.

Please return to us via fax at 858-430-4738 or by email to [email protected]. If you have any questions, please call customer service at 800-560-3800.