Patients and visitors
Medical Records
Release of information
A patient, or his/her legal representative, may inspect and/or obtain a copy of their medical records, or have copies of medical records sent to another facility for purposes of continued care.
Samaritan Healthcare requires a completed and signed Authorization for Release of Health Information form before releasing any documents to anyone, including the patient, along with photo ID to verify the patient’s identity. A patient’s physician, psychologist may also be required to approve the release of the medical record. The first copy of a medical record given to the patient is free of charge. Subsequent copies will be subject to the fees below. Copies going to medical providers for continued care are free of charge. Authorizations are only valid for one year.
Release of information charges for medical records and/or itemized billing
- $23 clerical fee
- $ 1.04 per page (up to 30 pages)
- $ .79 per page (each page after 30)
Radiology films and echocardiograms:
- 1st CD is free
- 2nd CD is $5 per film/sheet
Photo copies:
- $ 1 per 8.5“ X 11” sheet
Certification of records (for subpoenas):
- $ 2 each
To request a copy of your medical records
A HIPAA compliant authorization form must be completed by the patient or their authorized representative. The release must include all patient information, specific information to be released, dates of service, where information will be released to, purpose of disclosure and a valid patient ID. Upon receipt of the authorization form, Samaritan Healthcare has 14 days to complete the request. Requests are completed in the order which they were received in, with any continued care requests being first priority.
Additional information
If an individual other than the patient is picking up the records, the authorization must identify this patient as the one who the record is being released to.
Please allow up to 14 calendar days for your request to be processed. If you indicate you want to pick up your records, you will be contacted by the Release of Information staff when your records are ready. A photo ID is required at time of pick-up.
If you have any questions or concerns regarding our department or the services provided, please call me.
Donna Schipper, director
Revenue Cycle