The Medical Records Department at Ashland Community Hospital is responsible for maintaining patient records related to all services provided at the hospital.

Procedure to have your medical records released:

1. You may have your medical records released to you or your physician.
2. Download the "Release of Medical Information Form" by clicking here.  
3. Print the "pdf" file. 
4. Complete the form.
5. Fax the "Authorization to Disclose Protected Health Information to (541) 488-7413 or
   Mail to Ashland Community Hospital
   Medical Records Department
   280 Maple St.
   Ashland, OR 97520

Instructions for completing the "Release of Medical Information Form" 

1. Read carefully and fill out all of the blanks that pertain to the information you want or need.
2. Make sure you print or write legibly.
3. Your legal name is needed, not a nickname.
4. If you want the records mailed, make sure we have the full address.
5. If you want to pick up the records, make sure you include a phone number where we can reach you.
6. If you want someone else to pick up the records, please indicate on the release who that person is. 
7. We will need to see a picture ID of anyone who picks up the records.
8. There is a charge for records.  The first 5 pages are free.  The next 5 pages are $7.50.  Then it is $.50 per page.  If on microfilm, the charge is the same, except it is $1.00 per page after the first 10 pages.
9. If you need the records for a doctor's appointment, please state the date and time of your appointment and include the complete address of the doctor.
10. Make sure you date and sign the release.
11. Releases are done in the order in which we receive them.