Release of Patient Information
CHOC at Mission 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 one of the following formats: MyChart Patient Portal, email, fax, CD via mail, or paper via mail. You have the right to request that your health information be sent to any person or entity.
Medical records are maintained by the hospital for the time period required by state law, and some medical records may not be available.
How to request your medical records:
MyChart patient portal: The MyChart secure patient portal allows patients to view portions of their medical record and request copies of medical records that are not available through the portal. There are no fees associated with accessing medical records via MyChart. Learn more about MyChart.
Online: Complete all sections of the Patient Request to Access/Disclose a Designated Record Set form and submit online: English | Spanish
By Mail, Email or Fax: Download and complete all sections of the Patient Request to Access/Disclose a Designated Record Set form (English | Spanish). Mail, email or fax it to the address provided below.
Send a Letter: You may write a letter requesting your medical record. Be sure to include the following required elements:
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- Signed by the individual (patient) or patient representative
- Clearly identify the patient, preferably name and date of birth
- Clearly identify the intended recipient including name and address designated to receive the records
- Specify the date range, specific medical records, and name of facility where treatment was received
Send letters or completed forms to:
Providence St. Joseph Health Central Release of Information (cROI)
PO Box 4950
Portland, OR 97208
Phone: 1-855-234-2491
Fax: 1-855-234-2493
Send via email
In Person: Patients may request access to inspect their medical record by submitting a written request. Please follow instructions above to submit an “access to inspect” request. Once the request has been received, you will be contacted by a PSJH caregiver to schedule an appointment.
Important Information
Processing Time: Please allow up to 15 business days for processing your request.
Fees: There may be a fee associated with copying and mailing your records based on volume of medical records requested. The fees are based on State and Federal Regulations. An invoice will be provided with instructions for making payment.
Who Can Request: Only the patient or their legal guardian can request medical records. Patient representatives may need to provide supporting documentation to fulfill the medical records request e.g. Durable Power of Attorney, Advance Directive, guardianship or conservator forms.
Identification Required: Be prepared to provide a valid ID when requesting records in person or if otherwise requested.
Additional Information and Forms: For other medical record disclosure and amendment requests, please visit the Providence Mission Hospital website.
