Your completed and signed form can be submitted in person, faxed or scanned and mailed to the HIM Department. Unfortunately, we cannot accept an email without the scanned document showing your signature and date.
You also have the option of faxing or mailing a signed and dated letter to the HIM Department requesting your records instead of completing the request form. In this request letter, you must state the:
When care was received
What records you’re requesting
The purpose of requesting the records
Permission to release any information, including (if any) information about drug/alcohol/behavioral health or HIV
Address where the records should be sent
If you’re requesting records and are not the patient, the letter must state your relationship to the patient, such as “patient’s parent.” If you are not the patient and/or the patient is not a minor, you must include a power of
attorney.Records Needed for Care
If your records need to be sent to your doctor for follow-up care, you can include the doctor’s name and contact information on your authorization form. If your doctor needs copies of your medical records right away, ask his or her office to call
our HIM Department for copies.
Records for Personal Use
If your medical record copies are for personal use, there may be a charge for photocopying a large number of records. If there is a charge, we will contact you with an estimated cost of completing your request for your medical records.
Carondelet St. Mary’s Hospital
1601 W. St. Mary’s Rd. Tucson, AZ 85745 Phone: (520) 872-1087 Fax: (520) 872-4976
Carondelet St. Joseph’s Hospital
350 N. Wilmot Blvd. Tucson, AZ 85711 Phone: (520) 873-3843 Fax: (520) 873-6513
Carondelet Holy Cross Hospital
1171 W. Target Range Rd. Nogales, AZ 85621 Phone: (520) 285-8019 Fax: (520) 285-5997