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Request a Medical Record
Step 1 - Write Your Request
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
Submit Your Request by Mail or Fax
You may mail or fax your release form or letter to:
Samaritan Health Services
Health Information Department
Attn: Release of Information
PO Box 2728
Corvallis, OR 97339
Fax: 541-768-9363
Submit Your Request in Person
You may drop off your request or letter at the Health Information Management Department at Samaritan Health Services hospitals located in Benton, Lincoln and Linn counties. 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
3600 NW Samaritan Drive, Ste 181
Corvallis, OR 97330
3600 NW Samaritan Drive, Ste 181
Corvallis, OR 97330
- Phone:
- 541-768-5069
- Fax:
- 541-768-9363
Samaritan Albany General Hospital
Release of Information Desk
Health Information Management Dept
1046 Sixth Ave. SW
Albany, OR 97321
Release of Information Desk
Health Information Management Dept
1046 Sixth Ave. SW
Albany, OR 97321
- Phone:
- 541-768-5069
- Fax:
- 541-768-9363
Samaritan Lebanon Community Hospital
Release of Information Desk
Health Information Management Dept
525 N. Santiam Hwy
Lebanon, OR 97355
Release of Information Desk
Health Information Management Dept
525 N. Santiam Hwy
Lebanon, OR 97355
- Phone:
- 541-768-5069
- Fax:
- 541-768-9363
Samaritan North Lincoln Hospital
Release of Information Desk
Health Information Management Dept
3043 NE 28th St.
Lincoln City, OR 97367
Release of Information Desk
Health Information Management Dept
3043 NE 28th St.
Lincoln City, OR 97367
- Phone:
- 541-768-5069
- Fax:
- 541-768-9363
Samaritan Pacific Communities Hospital
Release of Information Desk
Health Information Management Dept
930 SW Abbey St.
Newport, OR 97635
Release of Information Desk
Health Information Management Dept
930 SW Abbey St.
Newport, OR 97635
- Phone:
- 541-768-5069
- Fax:
- 541-768-9363