As a patient, you have the right to receive copies of your medical records from Deaconess Hospital. In order to obtain copies of your records
or to authorize release of your medical records to another party, you must complete, sign and date the “Authorization to Use and Disclose
Protected Health Information” form. Please see the link below to download this form.
Click here to DOWNLOAD THE Authorization to Use and Disclose Protected Health Information FORM
[HAGA CLIC AQUÍ para obtener el formulario de autorización en español.]
To hand-deliver this form, visit the Health Information Department:
800 West Fifth Ave
Spokane, WA 99204
Located on the first floor near the Comprehensive Wound Healing and
Hyperbaric Chamber Center
Monday - Friday, 8:00 a.m. - 4:00 p.m.
Phone: (509) 473-7421
You may also fax this form to:
Deaconess Hospital Health Information Department
Fax: (509) 473-7522
Deaconess Hospital contracts with CIOX Incorporated, a professional medical record copying service, to ensure that your copies are available to you
as quickly as possible. Please allow up to 15 business days for us to process your request, even though we strive to make the copies available within 3
Prior to copying your records, CIOX Incorporated would like you to know that there will be a reasonable fee charged for this service and pre-payment may be required.
The ability to charge for copying of medical records, to cover the costs of labor and supplies, is mandated by the Washington State Legislature as
outlined in RCW 70.02.
We often recommend that you request only the pertinent parts of your medical record in order to limit the number of pages copied. This usually
includes all of the medical reports documented by the physician (e.g. discharge summary, operative reports, consultation reports) relevant progress
notes from your visit and diagnostic tests (e.g. Lab, Radiology, EKGs). CIOX Incorporated will contact you with the pre-payment amount. Medical records
will not be released until pre-payment is received.
If you have any questions, please call:
Deaconess Health Information Department
800 W. 5th Avenue
Spokane, WA 99204