Medical Records Request & Release of InformationPatient Authorization Form
Release of information must comply with State and Federal guidelines. Please contact Health Information at (801) 581-2704 between the hours of 8am – 4:30pm Monday through Friday if you have questions regarding the release of patient information.
A person requesting medical records must submit a written consent with the following information:
- Patient name, Date of Birth, contact information and last 4 digits of your SSN
- Information being requested and dates of service
- The name and address of the person the information is being released to
- The signature of the patient, signed within 1 year, (signature must be notarized or witnessed by a University of Utah Healthcare employee)
For direct patient care questions please call (801) 581-2353.