Patient Records & Health Information Management

If you would like to request copies of your medical records and/or a copy of your radiology images, please download and complete THIS authorization form (Adobe PDF format).

You can return the form via;
• mail it to the address on the form
• fax it to the fax number on the form
• the form can be emailed to roi@tetonhospital.org if you have the ability to scan
• drop the form off at the Health Information Management Department

The attached authorization needs to be completely filled out before medical records can be released.

For follow-up appointments, an authorization is not needed. You or your provider may call 307-739-7490 and request to have your medical records faxed directly to the provider.

If you would like assistance in completing the form, you can come to St. John's Health Information Management Department and we would be happy to assist you or you can phone us at the number listed above.

AttachmentSize
Authorization to Disclose Protected Health Information - PDF Format308.79 KB
AUTORIZACIÓN PARA DIVULGAR LA INFORMACIÓN PROTEGIDA SOBRE LA SALUD.pdf110.92 KB