HIM / Medical Records
Health Information Management
If you need any of the following services, please download the appropriate form:
- Release of Information Authorization / Medical Records Request to send your medical record from either the hospital or the clinic to a third party (i.e. another provider, your spouse, a family member, insurance company, etc.) or if you would like your treatment staff at VMC to speak with an individual other than yourself about your care (i.e. neighbor, friend, etc.)
- MyChart Consent Form to grant "Proxy Access" to your MyChart account so that a family member or other authorized person may access your MyChart account. To revoke MyChart access to a Proxy to whom you previously granted access, fill out a MyChart Proxy Deactivation Request form. Both forms must be signed in the presence of a clinic representative. All parties over age 17 must show ID at the time of signing. Washington State law prohibits MyChart access to records of children age 13-17.
- Amendment Request to amend or change a part of your medical record. The amendment must be approved by the provider before it is included in your medical record.
- Request for Additional Protection if you would like additional security measures to be added to your electronic medical record.
- Release of Information Notice contains the per page copy fee associated with obtaining a copy of your medical record for personal, legal or insurance use. You will not be charged for medical records copies sent directly to a physician, clinic, hospital or other health care provider.
|Please submit completed forms as follows:
- Mail to:
Valley Medical Center
400 S. 43rd Street
Renton, WA 98055
- Fax to the HIM office at 425.656.4026
- Email to RecordsRequest@valleymed.org
- Drop off at the HIM/Release of Information Office at the main hospital (just past the information counter in the main lobby)
For inquiries about your medical records, contact us by email us or call 425.251.5159.
Click here to access your MyChart account.