Forms:

To request copies of medical records, please print and complete the Authorization to Release Protected Health Information and then mail or fax it to the hospital. Please note that there is a form for each hospital - please complete the form for the hospital at which you received services.

Please click on the underlined link to view a form:

IntraCare Medical Center Hospital:   Authorization to Release Protected Health Information

IntraCare North Hospital:   Authorization to Release Protected Health Information

If you cannot view the form, please click here to download Adobe Acrobat Reader.