PATIENTS & VISITORS Medical Records A patient, or his or her legal representative, may inspect and obtain a copy of his or her 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 or psychologist may also be required to approve the release of the medical record. Copies going to medical providers for continued care are free of charge. Authorizations are only valid for 1 year. Release of Information Charges Click on the button below to view our fees associated with release of medical information services. Medical Record Request Fees To Request a Copy of Your Medical Records A HIPAA-compliant authorization form must be completed by the patient or his or her 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 in which they were received, with any continued care requests being 1st priority. If an individual other than the patient is picking up the records, the authorization must identify this patient as the one whom 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. Click on the button below to download an authorization form. Please fill out and return this form to obtain your medical records. ROI Authorization Form In person: Samaritan Hospital (1st Floor) 801 E. Wheeler Road, Moses Lake Hours: Monday-Friday 8:00 am to 4:00 pm By Fax: (509) 764-3214 Samaritan Hospital 801 E. Wheeler Road Moses Lake, WA 98837 509.765.5606 Map and driving directions Samaritan Clinic on Pioneer 1550 S. Pioneer Way Moses Lake, WA 98837 509.793.9770 Map and driving directions Samaritan Clinic on Patton 8420 Aspi Boulevard North Moses Lake, WA 98837 509.793.9781 Map and driving directions Select Language English Russian Spanish Select Language Copyright © 2020 Samaritan Healthcare. All rights reserved. Sitemap Nondiscrimination Policy Privacy Policy Samaritan Staff Portal