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Request Your Medical Record

Your Medical Record

Samaritan Health Services is committed to protecting your health information and requires specific written information from you in order to release your medical record.

If you are looking for your medical record as it relates to a past stay at one of our Samaritan hospitals or any of our Samaritan medical clinics throughout Benton, Lincoln and Linn counties, information about how to obtain copies of your medical records is provided below.

Simply download and complete the release form, or write us a letter following the instructions provided on this website (Step 1). Return it to the appropriate location listed on this website (Step 2). We will securely transfer your medical record according to your authorization as quickly as possible.

For your convenience, you may also access your own medical record to check on lab results or immunizations through your MyChart account.

Copies of Medical Records Are Available for:

Adult patients accessing their own medical records.
Parent or legal guardian accessing for their minor child.
Power of attorney with proof of legal representation.
Next of kin requesting medical records of a deceased family member, with proof of legal representation.

Request a Medical Record

Use a Release Form

Print release form.
Complete the form.
Deliver or mail the form to us.

Release Form (Other Organization)

Release Form (Personal Copy)

You can also request your records in a computer readable format.

Write a Letter

Your letter must include the following information:

Patient’s name.
Patient’s date of birth.
Date of visit.
Description of the information you are requesting (e.g., surgery report, X-ray report, discharge summary, etc.)
Purpose of your request (e.g., personal use, for you, physician, attorney, court, etc.)
Delivery address.
The requesting person’s name and signature.
The requesting person’s relation to the patient (e.g., parent, grandparent, sibling, self).
Copy of a photo ID.

Submit Your Request by Mail or Fax

You may mail or fax your release form or letter to:

Samaritan Health Services
Health Information Department
Attn: Release of Information
PO Box 2728
Corvallis, OR 97339
Fax: 541-768-9363

Submit Your Request in Person

You may drop off your request or letter at the Health Information Management Department at Samaritan Health Services hospitals located in Benton, Lincoln and Linn counties. Please bring identification with you.

Our offices are open 8 a.m. to 4:30 p.m. Monday through Friday, except on holidays.

Good Samaritan Regional Medical Center
3600 NW Samaritan Drive, Ste. 181
Corvallis, OR 97330

Phone: 541-768-5069

Fax: 541-768-9363

Samaritan Albany General Hospital
Release of Information Desk
Health Information Management Dept.
1046 Sixth Ave. SW
Albany, OR 97321

Phone: 541-768-5069

Fax: 541-768-9363

Samaritan Lebanon Community Hospital
Release of Information Desk
Health Information Management Dept.
525 N. Santiam Hwy
Lebanon, OR 97355

Phone: 541-768-5069

Fax: 541-768-9363

Samaritan North Lincoln Hospital
Release of Information Desk
Health Information Management Dept.
3043 NE 28th St.
Lincoln City, OR 97367

Phone: 541-768-5069

Fax: 541-768-9363

Samaritan Pacific Communities Hospital
Release of Information Desk
Health Information Management Dept.
930 SW Abbey St.
Newport, OR 97635

Phone: 541-768-5069

Fax: 541-768-9363

Receive Your Medical Records

Please allow us 30 days to process requests for medical records. Once our Health Information Management department receives your request, we will try to process your request within two weeks.

Fees: Standard rates apply for patient access requests that are disclosed directly to the patient or the patient representative.

No charge for up to 10 pages.
50 cents per page for 11 – 50 pages.
25 cents per page for all pages over 50.

Standard postage rates apply for requests that are mailed.

Third party requesters should contact the Health Information Management Department for the current fee structure.

We Protect the Privacy of Your Health Information

Protected Health Information is information about your health care that may include information that can identify you or is related to your health, the care received here or payment for care.

If you have a concern about a privacy issue during your treatment, tell your physician or nurse or the department manager. You may also contact our Compliance Department at 541-768-6218.