HOME/ MYCHART/ BILL PAY/ ABOUT US/ SPECIALTIES & SERVICES/ FORMS & RESOURCES/ CAREERS/ LOCATIONS/ CONTACT Medical Records / Health Information Medical Records Department WALK-IN TRAFFIC BY APPOINTMENT — PLEASE EMAIL OR FAX YOUR REQUEST FOR RELEASE OF INFORMATION 3011 Palmer Street PO Box 7609 Missoula, MT 59807 Phone 406-329-7263 Fax 406-329-7543 Hours of Operation: 8 - 4:30 Monday through Friday Authorizing release of your medical Information Complete and return to us the following form to authorize us to disclose your medical information. Please note that we share a medical record with Providence St. Joseph facilities (ie St. Patrick Hospital, Grant Creek, Broadway Internal Med, IHI, etc.), so there is no need to request records between us. If requesting only immunizations, please use the Immunization Record form. Authorization for Release of Information - General Authorization for Release of Information – Immunization Record The completed form may be faxed, mailed, or e-mailed (see the instructions page of the form for return contact information). Amending your medical record Complete and return to us the following form to request changes or additions to your medical record to make it more accurate or complete. Under certain circumstances, your provider may deny your request. If your request is denied, you have the right to add a short statement to the record. Request for Amendment Form Frequently Asked Questions Q. How do I get copies of my medical record? A. There are a number of ways to get access to you information: 1. You may find what you need in your MyChart account. Click here to access MyChart. 2. Have your provider contact medical records to request what they need. 3. Complete the Authorization for Release of Information, pay a fee if necessary, and provide photo identification. Q. Do I need to come to the office, or may I fax a request? A. The authorization form may be faxed, but we require a copy of a photo ID. Q. Can my spouse request my records? A. A spouse may only request records if they have an active medical power of attorney in effect. Contact Us | Forms | Your Opinion | Online Privacy Policy Language Assistance Available - Western Montana Clinic Notice of Non-Discrimination Copyright © 2021 - Western Montana Clinic - All Rights Reserved Western Montana Clinic uses cookies and other technologies, some of which are essential to make our website work. Others help us improve services and the user experience or to advertise. In using our site, you consent to the use of these cookies and other technologies. Learn more about our Online Privacy Policy, cookies and other technologies we use.