Medical Records


Requesting Your Medical Records

There are a few ways you can request copies of your medical records.

Online Medical Records:

You can access a great deal of your electronic medical record online using our patient portal Follow My Health.  Accessing the portal via your personal phone, tablet or computer allows you to directly access the content of your medical records contained within the portal. However, if you want a full and complete copy of your medical record, please see below.

How to Request Your Medical Records:

To request a copy of your medical records for yourself or to send to another healthcare provider, insurance company, attorney, school or other organization, complete an Authorization to Use and Disclose Form.

Note: All requests must be accompanied by proof of identity. A legible legal photo ID is preferred.

How to get your request to the Health Information Management Department:

  • Email: roiconfirm@summithealthcare.net  Please place the word “secure” in your subject line followed by your last name when emailing us.
  • Fax: 928-537-8358
  • Mail:

              Health Information Management Department
              Summit Healthcare
              2200 East Show Low Lake Road
              Show Low, AZ  85901

  • Walk-in: Due to COVID, our Customer Service window at the Administration Building is closed.

Other Information You May Need to Know:

If you are requesting records for a patient who lacks legal capacity or is unable to sign, an authorized personal representative may sign this authorization form. Written proof of authority must accompany the request to verify appropriate health information access for the following:

  • Court appointed guardian or other legally appointed representative
  • Executor/administrator/attorney in fact
  • Affidavit of next of kin
  • Power of Attorney

Verification of identity is required. Fees may apply. Some requests are subject to prior approval by the physician or therapist to release your health history.

Billing Records:

To request your billing records, please contact the business office at 928-537-6911.

Requesting a Correction, or Amendment, to Your Medical Record:

Please complete, date and sign the Request for Amendment Form. A copy of the content of your medical record in question displaying the visit date will help expedite the processing of your request.

Mail to:

Health Information Management – Attention: Director
Summit Healthcare
2200 East Show Low Lake Road
Show Low, AZ  85901

If you would like any of the above referenced forms mailed to you, please call 928-537-6326.

Frequently Asked Questions:

Can you give me my medical information over the phone?

No. Our medical records request process ensures your medical records are safely and confidentially maintained, while providing you ready access when you need them.

Will my radiology images be included in the medical record?

No. Images must be specifically requested by checking the appropriate box on the request form.

How do I obtain copies of medical records for those other than myself?

Minors: (patients under 18 of age): The parent or legal representative must complete, sign and date the Authorization to Use or Disclose Form, unless the minor is emancipated, homeless or married, or has legally consented to care without the need for separate parental consent. A legal guardian may be asked to provide proof of guardianship.

Patients 18 and over: Under most circumstance, patients over 18 must sign for themselves. If the patient has a legal guardian or representative, the legal guardian must provide proof of authority to complete the Authorization to Use or Disclose Form, on behalf of the patient.

Deceased patients:  To obtain a copy of a deceased patient’s record, you must provide a copy of the Death Certificate, complete, date and sign an Authorized Use or Disclose Form, and provide proof of authority and identity, such as:

  • Executor of Estate or Court ordered Administrator
  • Proof of next of kin, such as marriage certificate, birth records supporting lineage, or notarized Affidavit of Next of Kin

How long will it take to receive my medical record?

By law we are required to fulfill your request within 30 days of receipt, unless we notify you of the need for an extension of time to fulfill your request. We may notify you an additional 30 days is required.

We’re Here For You and Your Family

 

eMail a Patient

Summit Healthcare Urgent Care and Walk-In Clinics

Summit Healthcare Urgent Care Show Low

320 E Deuce of Clubs
Show Low, AZ, 85901
928-532-3926
Get Directions »

Summit Healthcare Urgent Care Pinetop

728 E White Mountain Blvd | Ste A
Pinetop, AZ, 85929
928-367-3926
Get Directions »