Request Your Medical Records
We're happy to offer multiple options to request and receive your medical records. The information below applies to all EvergreenHealth Hospitals and Clinics.
For Your Provider's Use
If the medical records are being sent directly to a health care provider, we will accommodate your needs and send the records out free of charge.
Just have your provider's office fax us a cover sheet with their letterhead requesting what specifically they need for your appointment.
For Your Personal Use
MyChart
To request access to your medical record. Patients have the right to request access to their own medical records. Patients are encouraged to utilize MyChart to obtain this information. If you are not able to utilize MyChart, you may request to receive copies, or to review the information, a request must be in writing and routed to Health Information Management for processing.
Patient Request for Health Information (PDF)
Sync.MD
Sync.MD is a personal health record solution that allows consumers to collect and share medical records directly using their smartphone.
The Sync.MD app is available on both the Apple App Store and Google Play; you can learn more at http://syncmd.com.
Contact help@syncmd.com with any questions or support needs.
Written Request for Medical Records to Third Parties
- Download the Authorization to Release Healthcare Information form [PDF].
- Complete the authorization form (must be a patient or patient's guardian/legal representative) and submit it via one of the methods below for processing.
- Email to: roi-him@evergreenhealthcare.org
- Fax to: (425) 899-1933
- Mail to: EvergreenHealth, Health Information Management MS-49, 12040 NE 128th Street, Kirkland, WA 98034
- Questions? Call (425) 899-1920 for assistance. Our business hours are Mon-Fri 8 a.m. - 5 p.m.
Radiology Imaging Requests
The actual radiology images are not part of your medical record, only the written reports.
Imaging can be requested in person at: EvergreenHealth Image Management Center, located on the Kirkland hospital campus in Purple 1-354. This window is staffed Monday through Friday from 7 a.m. - 7 p.m.
The HIM window at Monroe is no longer walk-up. Here are the steps to request images on a CD.
Submit a request (via ROI methods below) to get images burned to a CD. A CD containing the requested images will be mailed to the patient within 2 business days (via US mail).
- Release of Information (ROI) requests:
- MyChart: this is the preferred and fastest method to request ROI (use the MyChart app on your smartphone, or visit the EvergreenHealth MyChart page to log-in or sign-up.
- Call (425) 899-1920.
- Email ROI-HIM@evergreenhealthcare.org with completed request forms.
- Fax a request form to (425) 899-1933.
- Mail to: EvergreenHealth Kirkland, Health Information Management MS-49, 12040 NE 128th Street, Kirkland, WA 98034
Forms: For ROI, download a release form for your request at: Authorization to Release Healthcare Information form [PDF].
Expected turnaround time for ROI is 3-5 business days.
Billing Statements
Billing statements are not part of the medical record; however, you can request them in writing through the methods noted above under medical records, or you may contact the Patient Financial Services Department directly:
- EvergreenHealth Kirkland Patient Financial Services: (425) 899-1600
- EvergreenHealth Monroe Patient Financial Services: (360) 794-1495
Cost of Medical Record Copies
There is no charge for medical records to be sent directly to a health care provider.
Patient access charges for medical records requests for personal use:
- Records stored in electronic record system:
- Delivered electronically—$6.50
- Printed—$0.90 download + $0.05/page printing cost
- Records stored in a paper chart:
- Delivered electronically - $0.07/page copying cost
- Printed - $0.07/page copying cost + $0.05/page printing cost
- Records stored both electronically and in paper chart:
- Delivered electronically - $6.50 + $0.07/page copying cost
- Printed - $0.90 download (electronic record) + $0.07/page copying cost (paper record) + $0.05/page printing cost
- Plus sales tax and postage if applicable
You will be receiving an invoice from Datavant/Ciox Health for the requested copies of your medical records as they are our authorized vendor for records requests.
Amendment Request to Your Medical Records
Right to request an amendment to your medical information if you believe our records are incomplete or inaccurate. Your request for amendment must be in writing and provide the reason for your request. In certain cases, we may deny your request. If so, we will notify you in writing. You may respond by filing a written statement of disagreement with us and ask that the statement be included with your medical information.
Download form (PDF)
Amendment Request Process Patient FAQ
Send the completed form to the EvergreenHealth Health Information Management department by one of the following methods:
- Email to: roi-him@evergreenhealthcare.org
- Fax to: (425) 899-2064
- Mail to: EvergreenHealth, Health Information Management MS-49, 12040 NE 128th Street, Kirkland, WA 98034
- Questions? Call (425) 899-1930 for assistance. Our business hours are Mon-Fri 8 a.m. - 5 p.m.
Frequently Asked Questions
Who do my medical records belong to?
Your medical record is the property of EvergreenHealth and is kept by the hospital for patient care purposes. Although these records are maintained for your benefit, the physical records (paper or electronic) are the property of the hospital. The information within your medical records is yours.
Who may request medical records?
You may request copies of your own medical records, the medical records of a minor child, or the medical records of someone for whom you are the legal guardian or hold a Durable Power of Attorney for Healthcare. Proof of legal guardianship or a Durable Power of Attorney for Healthcare must be provided.
A Durable Power of Attorney for Healthcare is only effective in the event a patient is unable to act on their own behalf and that has been determined by a physician.
A spouse or child of a deceased patient can request the medical records of the deceased if he/she is the executor or administrator of the deceased patient's estate. Probate Court documents naming the requestor as the executor or administrator must be provided.
Where there is no estate or an estate will not be probated, Probate Court documents releasing the estate from probate and naming the requestor as the personal representative must be provided. Next of Kin would be followed if the medical record supports release to the requestor.
How soon can I expect the release of my medical record?
Washington state law requires that medical records be released within 15 business days of the request. However, we typically are able to honor all requests within a week or so. Requests for older records may take longer as they are kept in a secure off-site storage facility.
How long do you keep a medical record?
Washington State law requires that hospitals keep a patient's medical record for up to 10 years following their most recent discharge. Hospitals must keep the medical records of minors until the minor reaches the age of 21, or for at least 10 years following the minor's discharge, whichever is longer.
How do I request a copy of a birth certificate or death certificate?
Contact the King County Vital Statistics office for birth and death certificates at (206) 897-5100 or visit the Washington State Department of Health for more information.
