ROI – Release of Protected Health Information

Obtaining a copy of your Mountains Community Hospital medical record is easy. To start your request, simply download, print, complete, sign and return the form.

Return your completed form to the Patient Financial Assistance window at the main entrance of the Hospital or mail or fax the request.

Mailing Address:

Mountains Community Hospital
Health Information Management (Medical Records)
PO Box 70
Lake Arrowhead, CA 92352
Fax Number: 909-336-9302
Telephone Number: 909-436-3060

Please be sure to sign the form. Unsigned requests cannot be processed.

Requests will be processed upon receipt up to 15 business days.   We will either mail it to the address specified on the authorization form, or you may pick it up at our office.

Once they are ready, your records can be picked up between the hours of 9:00 am and 4:00 pm Monday-Friday.

> Download Request Form

mch_pic_examine