Medical Records Release of Information Consent Form (CLICK TO OPEN)
Medical Records Release of Information Consent SPANISH Form (CLICK TO OPEN)
Platte Valley Medical Center’s Health Information Management Department (HIM) is located on the first floor of the Medical Center. The hours of operation are Monday thru Friday from 8:00 a.m. to 5:00 p.m. The HIM department maintains all medical records with integrity, security and confidentiality of all patient health information. Copies of medical records may be obtained by one of the following:
1. Printing off the release of information authorization form below. The form needs to be filled out completely and returned to the HIM department. This may be faxed to the HIM department at 303-498-1677. The release must be accompanied with a copy of a picture ID of the person signing the release and a contact telephone number. Records will be mailed to the requesting party. If the release is not filled out completely this will delay receiving the records.
2. Visiting the HIM department and completing a release of information authorization form. Please bring a picture I.D. with you for identification purposes.
3. If records are being requested by someone other than the patient please provide proper documentation proving the right to patient’s medical records, such as a Health Care/Medical Power of Attorney, death certificate, guardianship, etc. The person listed in these documents must sign on the 2nd page and note on the last line what the basis for legal authority to sign the authorization by a personal representative is, such as parent, guardian or etc.
4. Requests will be completed while you wait if there are only a few pages that are needed. If there is a larger volume we will arrange with you for the records to either be mailed or picked up at a later date.
Health Information Management Department contact information:
Platte Valley Medical Center
HIM Department
1600 Prairie Center Parkway
Brighton, CO 80601
Phone # 303-498-1640
