HIM / Medical Records
Health Information Management
If you need any of the following services, please download the appropriate form, fill it out, date and sign it, then return to us by one of the methods listed below:
- Release of Information Authorization / Medical Records Request (For Fillable PDF, click here) is required 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.) There is a 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. You may also have your
records released directly into MyChart at no cost to you. For additional
information on how to sign-in or sign-up for MyChart, click the hyperlink at the top of
- Parents or guardians may request access to their child or ward's MyChart account. You may also permit a family member or other authorized person to access your MyChart account, if you so wish. This permission is referred to as "Proxy Access" and must be made in writing. To revoke MyChart access to a Proxy to whom you previously granted access, you should fill out a MyChart Proxy Deactivation Request Form. Both forms must be signed in the presence of a clinic representative. Ask for the form at the front desk. All eligible parties must show ID at the time of signing. Washington State law prohibits MyChart proxy access to records of children age 13-17.
- Amendment Request (For Fillable PDF, click here) 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 (For Fillable PDF, click here) if you would like additional security measures to be added to your electronic medical record.
|Please submit completed forms as follows:
- Mail to:
Valley Medical Center
400 S. 43rd Street
Renton, WA 98055
- Fax to the HIM office at 425.690.9407
- Email to RecordsRequest@valleymed.org
For inquiries about your medical records, contact us by email or call 425.690.3406.
Click here to access your MyChart account.