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Request Your Medical Record
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 Samaritan hospitals or any of our Samaritan medical clinics throughout Benton, Lincoln and Linn counties, information about how to obtain copies of your medical records is provided below.
Simply download and complete the release form, or write us a letter following the instructions provided on this website (Step 1). Return it to the appropriate location listed on this website (Step 2). We will securely transfer your medical record according to your authorization as quickly as possible.
For your convenience, you may also access your own medical record to check on lab results or immunizations through your MyChart account.
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
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
3600 NW Samaritan Drive, Ste 181
Corvallis, OR 97330
- Phone:
- 541-768-5069
- Fax:
- 541-768-9363
Release of Information Desk
Health Information Management Dept
1046 Sixth Ave. SW
Albany, OR 97321
- Phone:
- 541-768-5069
- Fax:
- 541-768-9363
Release of Information Desk
Health Information Management Dept
525 N. Santiam Hwy
Lebanon, OR 97355
- Phone:
- 541-768-5069
- Fax:
- 541-768-9363
Release of Information Desk
Health Information Management Dept
3043 NE 28th St.
Lincoln City, OR 97367
- Phone:
- 541-768-5069
- Fax:
- 541-768-9363
Release of Information Desk
Health Information Management Dept
930 SW Abbey St.
Newport, OR 97635
- Phone:
- 541-768-5069
- Fax:
- 541-768-9363
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.
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.