Dignity Health North State medical records

You have the right to get a copy of your medical records. You can also ask for your records to be sent to another person or organization. This could be another health care provider, a family member or a legal representative.

To request your records, complete an authorization for the release of health information form. You can submit the form by mail, fax or in person at one of our medical records departments. Clearly state who can receive your records and for what purpose.

To obtain a copy of your medical or billing records for yourself, please download and complete one of the forms below:

• English: Patient Access Request Form

• Spanish: Formulario de solicitud de acceso al paciente

To have your medical or billing records sent to someone else, please download and complete the Authorization to Disclose Form.

• English: Authorization to Disclose Form

• Spanish: Autorización para divulgar información

After completing the form, please mail your request to:

Mercy Medical Center Mt. Shasta
914 Pine Street
Mt. Shasta, CA 96067

You may also fax your completed form to (530) 926-3840. Questions? Please call (530) 926-9341.

To obtain a copy of your medical or billing records for yourself, please download and complete one of the forms below:

• English: Patient Access Request Form

• Spanish: Formulario de solicitud de acceso al paciente

To have your medical or billing records sent to someone else, please download and complete the Authorization to Disclose Form.

• English: Authorization to Disclose Form

• Spanish: Autorización para divulgar información

After completing the form, please mail your request to:

Mercy Medical Center Redding
2175 Rosaline Avenue
Redding, CA 96001

You may also fax your completed form to (530) 225-7279. Questions? Please call (530) 225-6141.

To obtain a copy of your medical or billing records for yourself, please download and complete one of the forms below:

• English: Patient Access Request Form

• Spanish: Formulario de solicitud de acceso al paciente

To have your medical or billing records sent to someone else, please download and complete the Authorization to Disclose Form.

• English: Authorization to Disclose Form

• Spanish: Autorización para divulgar información

After completing the form, please mail your request to:

St. Elizabeth Community Hospital
2550 Sister Mary Columba Drive
Red Bluff, CA 96080

You may also fax your completed form to (530) 529-8165. Questions? Please call (530) 529-8170.