Step 1
Download and Complete the Form

Download the Medical Records Release form, fill out all required fields, and sign the form to authorize the request. Proceed to Step #2 or return this form to the front desk at your hospital.

  • To Avoid delays, ensure all fields are completed, including your signature.
Medical Records Request Form Download
Step 2
Upload the Signed Form

Use the secure upload form below to submit your completed request.

  • You will receive an email confirmation once your submission has been successfully received
  • If you prefer NOT to upload your form online, you can also return the completed form to the front desk at your hospital location.
Step 3
Pick Up Records at Your Hospital Location

After submitting your request in Step #2, you’ll receive a confirmation message.  When picking up your records, please bring a valid photo ID to verify your identity. For questions or to confirm the status of your request, contact the phone number listed for your hospital location below.

Bullhead City, AZ

2365 HWY 95
Bullhead City, AZ  86442
(928) 224-2443

10960 North John Wayne Parkway
Maricopa, AZ  85139
(520) 534-0700

2648 S. Araby Rd
Yuma, AZ  85365
(928) 877-0400

4822 AZ-69
Prescott, AZ  86301

340 E Milligan Rd
Eloy, AZ  85131

2670 Pinon Frontage Rd.
Farmington, NM  87402

1641 Woerz Way
Ardmore, OK  73401
(580) 826-3080

6401 Spur 327
Lubbock, TX 79424
(806) 630-4501

Frequently Asked Questions
How long does it take to process my request?

Medical records are typically ready within 24-48 hours after submitting the completed form.

You may check the status of your request by calling the front desk of the hospital location you submitted your request to. Each location information is listed in Step #3 above.

Yes. You will need to provide proof of identification to pick up your medical records at the front desk.

Yes, you can authorize someone to pick up your records by indicating this on your request form. They will also be required to show proof of identification at the front desk.

For security reasons, records can ONLY be picked up in person or faxed to your designated medical provider.

Exceptional Community Hospital does not charge patients for a copy of their health records.

Care

accessible Healthcare

All of our Arizona hospitals are now in-network with Blue Cross® Blue Shield® of Arizona, an Independent Licensee of the Blue Cross Blue Shield Association. We also accept all insurance plans, including Medicare, Medicaid, and TRICARE. Even if we are out of network with your insurance, we will honor your in-network benefits in accordance with the Federal No Surprises Act.

After you receive care at one of our hospitals, you may receive an Explanation of Benefits (EOB) from your insurance carrier. The EOB is NOT A BILL.

Depending on your health insurance carrier, you may be responsible for a copay, deductible, and co-insurance. Your health insurance carrier will process this for services rendered.

Thank you for making us your hospital of choice.

Care

accessible Healthcare

Exceptional Community Hospitals currently accept all commercial insurance plans, Medicare, Medicaid, and Tricare. We also honor all in-network benefits for emergency services in accordance with the Federal No Surprises Act.

After you receive care at one of our hospitals, you may receive an Explanation of Benefits (EOB) from your insurance carrier. The EOB is NOT A BILL.

Depending on your health insurance carrier, you may be responsible for a copay, deductible, and co-insurance. Your health insurance carrier will process this for services rendered.

Thank you for making us your hospital of choice.

ER Tower

Access Your Payment Portal

To ensure you reach the correct records, please select your hospital location below.

Ardmore, OK
Bullhead City, AZ
Lubbock, TX
Maricopa, AZ
Prescott, AZ
Yuma, AZ