Request for Medical Records

ROI - Release of 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.

You may return your completed form with the $15 search fee to the Patient Financial Assistance window at the main entrance of the hospital. Or, if you have completed the credit card portion of the request form you may 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) 436-3061

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

Your request will be processed and fulfilled within 15 business days from the day it was received. Please allow reasonable time to process your request. We will either mail it to the address specified on the authorization form, or you may pick them up at our office upon making arrangements with the release of information staff.

Records can be picked up between the hours of 9:00am and 4:00pm, Monday - Friday.

There is an additional 10 cent per page copying fee after 50 pages.

Download the Release of Information Form [PDF]