If you would like to request copies of your medical records and/or a copy of your radiology images, please download and complete this authorization form (Adobe PDF format).
You can return the form by:
• mailing it to the address on the form
• faxing it to the fax number on the form
• emailing the form to firstname.lastname@example.org if you have the ability to scan
• dropping the form off at the Health Information Management Department
The attached authorization needs to be completely filled out before medical records can be released.
For follow-up appointments, an authorization is not needed. You or your provider may call 307 739 7490 and request to have your medical records faxed directly to the provider.
If you would like assistance in completing the form, you can come to St. John's Health Information Management Department and we would be happy to assist you or you can phone us at the number listed above.