As a result of the COVID-19 pandemic, we are requesting patients to mail or fax their requests for records to the address or phone number below. If you need medical records for a doctor’s appointment, please have your provider request your records prior to your appointment.
Please note: We have 30 days to fulfill all requests. However most are fulfilled within 3-5 business days. Please allow time for the records to be mailed. If we cannot fulfill your request within 30 days, you will receive written notification.
The Health Informatics and Information Management department maintains medical records related to your care received at all Mesa View Regional Hospital. The release of confidential medical records is protected by federal regulations established by the Health Information Portability and Accountability Act (HIPAA). Copies of records may be released upon receipt of a completed Authorization to Disclose Protected Health Information form. This should be completed by the patient (18 years of age and older) or parent/legal guardian.
Download the Release of Medical Information form here.
Please fill out all highlighted sections, including:
- Patient’s Name, Date of Birth, Address and Phone Number
- Facility Authorized to Release Information to:
- Records Released to you – write in “SELF”
- Records Released to another Provider or Facility – please fill in the Providers name, address, phone and FAX number.
- Health Information to be disclosed – include all dates of service, what type of records you want released (labs, x-ray, complete, etc.), why you need the information (treatment, insurance, personal),
- Ensure the Sensitive Information section is understood and completed by checking “Yes” or “No”. Failure to make this selection may delay the release or result in a denial of the request.
- Patient’s or Authorized Personal Representative’s Signature – please sign, date and time.
- Leave the Witness Signature line and everything below it blank.
You will also need to include a legible copy of your driver’s license or your Official ID so we may verify your signature with your hospital record.
For services provided at Mesa View Regional Hospital, please mail or fax the forms to:
Mesa View Regional Hospital
Attn: Medical Records/Share Care
1299 Bertha Howe Avenue
Mesquite, NV 89027