Patient Health Records
The following items are required:
- Authorization for Release of Health Information (filled out, signed and dated by the patient)
- State issued identification from the requestor
- CHS Web Form
Remember when filling out the Authorization for Release of Health Information form the following are required:
- All sections must be completed
- The patient must fill out, sign and date the Authorization
- The Authorization will need to be returned to the Health Information Management staff for processing
- Remember to include a copy of the state issued identification from the requestor
- Only completed documents will be processed
- You can download the Authorization for Release of Health Information form by clicking the link below
- You may upload the completed Authorization along with a copy of state issued identification of the requestor on the CHS Web Form (click here or link below). Please note one document per upload.
- You may electronically send the Authorization along with a copy of state issued identification of the requestor to the following email address: CHSHIMROI@Maricopa.gov
- You may fax your completed Authorization request, along with a copy of the state issued identification of the requestor to the following fax number 602-253-4931.
- You may mail your completed Authorization along with a copy of state issued identification of the requestor to: Maricopa County Correctional Health Services
Attn: Health Information Management
201 S 4th Avenue, Phoenix, AZ 85003
NOTE: You will be notified electronically by automatic response that your request has been received. Generally, within 7-10 business days you will be contacted. Payment instructions will be included within the fee letter you receive once your request has been approved.
Please DO NOT mail or submit payment until notified to do so. You will receive confirmation when your request is approved and you will be notified of the dollar amount required for the service.
Please complete the CHS Web Form.
- Electronic records are a flat fee of $6.50 for standard requests for records that are maintained and fulfilled electronically
- Paper copies are $10.00 for the first 10 pages and $.50 for each additional page
Closed weekends and holidays