How to Request a Copy of Your Medical Records

 

Plumas District Hospital is happy to provide you with a copy of your health information.  To request a copy of your records, please fill out the form:

 

>>Authorization For Use Or Disclosure Of Health Information form

 

and return it to the fax number or email provided below. (This contact information is also listed on the form). You will need to fill out the form completely, with your full name and contact information, birth date, and the specific treatment dates you are seeking. Please include a photocopy of your photo ID. We provide the first request at no cost to you.

 

Our staff will contact you regarding receipt of your request, expected turnaround time and payment due. For security purposes, at the time records are delivered to you, you will need to provide proper identification.

 

If you are requesting more than 20 pages, the following fee schedule based on California state law, will be used to determine the charges:

  • 0.10 cents per page for 8.5x14 inches or less

  • 0.20 cents per page for microfilm

  • Actual costs for the reproduction of oversize documents or the reproduction of documents requiring special process which are made in response to a subpoena

  • The reasonable cost of clerical costs incurred in locating and making records available

  • Actual postage charges

Contact Information

Plumas District Hospital

Health Information Management
1065 Bucks Lake Road

Quincy, CA 95971

 

Phone: 530-283-7122
Fax: 530-283-7197

Email to medicalrecords@pdh.org

 

Hours for medical records requests:
Monday - Friday: 8 a.m. to 5 p.m.
Closed on holidays

 


  

       

      

       

       

 

           

 

 

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