For Patients


To receive copies of your medical records, you must submit a written, signed, and dated request form. You may download, print and complete the Authorization for Use or Disclosure of Health Information in English or in Spanish.

Mail, email or fax your completed request to:

St. Mary Medical Center
Health Information Management

Attn: Release of Information
18300 Highway 18
Apple Valley, CA 92307
Fax #: (760) 946-4219

Deliver in person to:
16071 Kasota Rd, Suite 401
Apple Valley, CA 92307

You have an option of receiving your information on a CD, paper copies, email or fax. Please indicate your preference on the authorization form. Most requests are completed within 3 – 5 business days of receipt of authorization. In some instances, requests may require additional time to process.

When presenting in person to request or pick up records you will be required to show photo identification.

Valid Authorization

Medical records/billing information may be released to anyone that the patient authorizes in writing to receive such information. A valid authorization MUST contain the following information:

  • Patient’s full name
  • Date of birth
  • Specific information to be released (i.e. lab report) and the date of service
  • Purpose for which the information may be disclosed (continuing care, insurance, disability, personal use)
  • To whom the information is to be sent to including the name and address or who will pick up the information
  • Specify when the authorization will expire
  • Identify if you would like a copy of the authorization
  • The patient’s signature or a patient’s legal representative’s signature. Authorizations signed by a representative must include a copy of the durable power of attorney, guardianship, etc.
  • Date of the signature

Information pertaining to mental health treatment, HIV, and alcohol and drug are designated as sensitive information. In order to release this information, the authorization specifically states this. The authorization requires your initials and date for the specific sensitive information you request.

In the event of a large request for medical information, St. Mary Medical Center utilized Sharecare to fulfill these requests. Please note that there may be a fee associated with this type of request. If you have any questions regarding fee, please contact Sharecare at (760) 242-2311 extension 5390.

If you have any questions regarding obtaining copies of medical records/billing information please contact Health Information Management at (760) 242-2311 extension 6100.

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