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Your Medical Record

Samaritan Health Services is committed to protecting your health information and requires specific written information from you in order to release your medical record.

If you are looking for your medical record as it relates to a past stay at one of our hospitals or any of our medical clinics throughout Benton, Lincoln and Linn counties, please call or visit Health Information Management at any of our locations to start the process.

Our staff will provide you with the necessary paperwork to authorize the release of your medical records. Simply fill out the form provided and return it to the appropriate location. We will securely transfer your medical record to you, your doctor or health insurer as quickly as possible.

If you would like to access your own medical record to check on lab results or immunizations, please do so through your MyChart account.

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Copies of Medical Records Are Available for:

  • Adult patients accessing their own medical records
  • Parent or legal guardian accessing for their minor child
  • Power of attorney with proof of legal representation
  • Next of kin requesting medical records of a deceased family member, with proof of legal representation

 

Request a Medical Record

Step 1 - Write Your Request

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Use a Release Form

  • Print release form
  • Complete the form
  • Deliver or mail the form to us

Release Form Download Links (PDF)

ENGLISH SPANISH

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Write a Letter

Your letter must include the following information:

  • Patient's name
  • Patient's date of birth
  • Date of visit
  • Description of the information you are requesting (e.g., surgery report, X-ray report, discharge summary, etc.)
  • Purpose of your request (e.g., personal use, for you, physician, attorney, court, etc.)
  • Delivery address
  • The requesting person's name and signature
  • The requesting person's relation to the patient (e.g., parent, grandparent, sibling, self)
  • Copy of a photo ID

Step 2 - Submit Your Request

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Submit Your Request by Mail

You may mail your release form or letter to the Health Information Management Department at your local hospital.

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Submit Your Request in Person

You may drop off your request or letter at the Health Information Management Department at any Samaritan Health Services hospital. Please bring identification with you.

Our offices are open 8 a.m. to 4:30 p.m. Monday through Friday, except on holidays.


Our Locations

Good Samaritan Regional Medical Center
Release of Information Desk
Health Information Management Dept
3600 NW Samaritan Drive
Corvallis, OR 97330
Samaritan Albany General Hospital
Release of Information Desk
Health Information Management Dept
1046 Sixth Ave. SW
Albany, OR 97321
Samaritan Lebanon Community Hospital
Release of Information Desk
Health Information Management Dept
525 N. Santiam Hwy
Lebanon, OR 97355
Samaritan North Lincoln Hospital
Release of Information Desk
Health Information Management Dept
3043 NE 28th St.
Lincoln City, OR 97367
Samaritan Pacific Communities Hospital
Release of Information Desk
Health Information Management Dept
930 SW Abbey St.
Newport, OR 97635

Receiving Your Medical Records

Please allow us 30 days to process requests for medical records. Once our Health Information Management department receives your request, we will try to process your request within two weeks.

Fees: Standard rates apply for patient access requests that are disclosed directly to the patient or the patient representative.

No charge for up to 10 pages
50 cents per page for 11 - 50 pages
25 cents per page for all pages over 50

Standard postage rates apply for requests that are mailed.

Third party requesters should contact the Health Information Management Department for the current fee structure. 

Minimize Costs & Delays

Requests for all of your medical records including progress notes, consent forms, registration forms and more, can delay the request process and become costly. If you are requesting information for continuing patient care or an overview of care received, a request for Pertinent Records is probably sufficient.

A request for Pertinent Records includes provider reports, problem list, medications, immunization and allergy lists, lab, X-ray and other test results if any, for the time period specified in the patient/patient representative's authorization.

We Protect the Privacy of Your Health Information

Protected Health Information is information about your health care that may include information that can identify you or is related to your health, the care received here or payment for care.

If you have a concern about a privacy issue during your treatment, tell your physician or nurse or the department manager. You may also contact our Compliance Department at 541-768-6218.