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



Form Submission

To obtain your medical record, please bring all of the documents listed below to the Medical Records Department at Brigham City Community Hospital. We are available to accept medical records requests between the hours of 8:00 am and 5:00 pm Monday thru Friday.

  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)

Please be aware that it may take 5-7 business days to receive your records.

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.

Contact Information

If you have additional questions, you can call our Release of Information specialists at (435) 734-4147 or toll-free at 866-270-2311. You can also fax your request to the toll-free fax number at 877-865-9738.

Read more about our responsibilities and your rights for privacy.