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Health Records Request

To request a copy of your Health Records/ Health Information, download, fill-out, and submit the applicable Health Information Form below. To streamline the process we have partnered with a new vendor, Record Connect, who will be distributing health records for SEARHC, for all instances, except pick-up.  For questions regarding all submitted requests, please contact Record Connect at 907.931.1391.

Which form should I use?

Need assistance determining which form you should use? Let us help.

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Please include a copy of your valid identification when submitting email or fax requests.  Be prepared to show your identification upon picking up your medical records.

  1. If you are requesting your own records, or are the legal personal representative (e.g.guardian) of the individual and want copies for yourself or to have the records sent to someone, please use this fillable form: Patient Request for Access to Personal Health Information
  2. If you are a third-party (e.g. lawyer, school, insurance company, or employer) please use this fillable form: Authorization to Disclose Protected Health Information
  3. If you are requesting Behavioral Health records, please complete the following release of information (ROI) fillable form: Authorization to Disclose Behavioral Health Protected Information

How to Electronically Sign the Form

If you wish to fill out the form on your computer instead of printing it out and filling it in manually, follow these instructions.

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  1. Download the form.
  2. Open it in Adobe Acrobat Reader.
  3. Type your information into the form.
  4. Then select “Fill & Sign” to use the pen tool for your signature, or initials as requested.

How to Return the Form

You may mail, fax, or email your request form.

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Mail Option:
Mailing address:
HIM Department
3100 Channel Drive, Ste 300
Juneau, AK 99801
Please include a copy of your valid identification when submitting any requests, or you may show your identification upon picking up your medical records.

Email Option
Email: release@searhc.org
Please note that you will need to include a form of ID if you email your request.

Fax Option
Fax: 907.463.4012
Please note that you will need to include a form of ID if you fax your request.

For more information, call 907.463.6630