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
Mail, fax, or hand-deliver your completed request to:
St. Mary Medical Center
Health Information Management
16071 Kasota Rd., Suite 401
Apple Valley, CA 92307
Phone: (760) 242-2311, ext. 6100
Fax: (760) 946-4219
Hours of Operation: 8 a.m. to 4:30 p.m., Monday through Friday
18300 Highway 18
Apple Valley, CA 92307
When picking up your copies you will be required to show photo identification.
Please note it takes approximately 10 to 15 working days to process a request.
Medical records 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 (including any former name)
- Patient’s date of birth
- Specific information to be released (i.e. lab report, imaging report) and
date of service
- Purpose for which the information may be disclosed (continuing care, insurance,
- To whom the information is to be sent to including name and address or
who will pick up the information
- Expiration date when the authorization is no longer valid
- 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 signature
Information pertaining to mental health treatment, HIV and alcohol and
drug use are designated as sensitive information. In order to release
this information, the authorization must specifically state this. There
are check boxes on the authorization that should be checked and initialed
if this information is requested.
For more information about requesting records, please read
There may be a fee associated with the production of your medical records.
St. Mary Medical Center utilizes BACTES Imaging Solutions. If you have
questions regarding the fee, please contact BACTES at (714) 882-5886.
If you have any questions regarding obtaining copies of your medical records,
please contact Health Information Management at (760)242-2311, ext. 6100