Release of Information Consent Form instructions.
If you would like to receive a copy of your Health Records, please click on the link below and fill out the "Authorization to Release Protected Health Information."
Please make sure the necessary information is on the consent form to assure locating your records. This would include:
Name, Date of Birth, Address, Telephone Number, Date of Service that you are requesting.
Please specify if the records are to be mailed to you or another person of your choice. If it is your physician, please provide the mailing address or fax number.
Please sign the consent form for identification purposes.
You may fax or e-mail this consent form back to Yuma Regional Medical Center.
| Fax: | 928-336-7154 |
| Attn: | Lorna L. Warden |
| Email: | lwarden@yumaregional.org |
If you are in need of personal assistance, please contact Lorna Warden directly at 928-336-7345.
Change in the Medical Record Information instructions.
If after receiving your Health Records you feel there is a discrepancy, on any of the reports, please fill out a "Change in the Medical Record" form and send back to the Health Records Department in person, by faxing (928-336-7154) or via e-mail dfoxford@yumaregional.org .
Please include your name and telephone number on the form in the event we need to contact you. In the space provided please state what you are requesting to be changed and what document(s) the error is on. By signing this form, you are giving us permission to contact the physician of record in regard to your request. Please allow 3-6 weeks for your request to be completely processed. Click here to download the Change of Medical Information Form.
Birth Certificates instructions:
Yuma Regional Medical Center does not have access to birth certificates. Please contact "The Department of Vital Statistics" at 602-364-1300. They will be able to assist you with the paperwork for the processing and ordering of birth certificates.
 Release of Information Consent Form
Change of Medical Information Form
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