Protecting your confidential health information is important to us. Our Health Information Management department maintains your medical records to remain safe and available to you when you need them. Your medical record summarizes the services you have received at Moab Regional Hospital and our clinics. Access to medical records is available to patients and legal guardians.
Authorization for Disclosure of Protected Health Information
Depending on the amount of information requested and the medical significance, Medial Releases of Information may take up to 10 business days but no longer than 30 days. Information located off-site or authorization forms that are improperly filled out take longer to process.
If your request requires a fee, you will be notified of the fee before the record is sent.
To request a copy of your medical record, please complete the Patient Authorization for Disclose of Protect Health Information (orange button on the right). Please use blue or black ink, and print clearly and legibly. All fields must be completed before we can process your request.
- First 10 Pages are Free
- Black and White copies after the first ten pages: $.50 per page
- Radiology Images on CD – Call for pricing
Completed forms can be dropped off or mailed to:
Moab Regional Hospital
Attn: Medical Records Department
450 Williams Way
Moab, Utah 84532