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Medical Records

Medical Records

At Mountain Vista Medical Center and Florence Hospital, a Campus of Mountain Vista Medical Center
To request your medical records, please visit the Health Information Management department in Mesa between the hours of 8 a.m. to 4:30 p.m, Monday through Friday, or call 480-358-6400.

Prior to receiving copies of records or authorizing records to be disclosed, you will be asked to complete the appropriate form and provide proof of your identification with a valid, government-issued photo ID.

The appropriate form, along with a copy of your proof of identification, may be faxed to 480-358-6407. Requests for medical records generally take up to 72 hours to process.

Requesting PHI

The following form should be used for requests to inspect or obtain a copy of one’s own records or those of a patient for whom you are the legal representative.

Request a Copy of PHI (English)

Request a Copy of PHI (Español)

Requesting Records

The following form should be used for requests to disclose medical records to a third party.

Authorization to Release Records (English)

Authorization to Release Records (Español)

Records needed for continuing care purposes do not require the completion of any of the above-referenced forms, but rather will be sent directly to your provider.