Health Records Request
If you need a copy of your Health Records or Health Information for pick-up, or to be faxed to a provider, simply download, print, fill-out and return the following form to us via fax or email. Please include a copy of your valid identification when submitting any requests, or you may show your identification upon picking up your records. Please note that you will need to include a form of ID if you do email or fax your request.
The ROI and medical records department in the the Inuit Building is open 8 a.m.- 5p.m. Monday-Friday. This department follows the ANMC holiday schedule for closures.
Please have your ID ready. If the records cannot be emailed, mailed or faxed, the Health Records representative will set up an apt for the patient to come back to pick up the records.
Commonly requested forms:
- Authorization for Use and Disclosure of Health Information form [PDF]
- Request for Revocation of Restrictions form [PDF]
- Request for Amendment to Protected Health Information form [PDF]
- Revocation of Authorization for Disclosure of Health Information form [PDF]
- Request for Restriction on Use and Disclosure form [PDF]
- Request for an Account of Disclosures form [PDF]
Hours: 8 a.m.-5 p.m. Monday-Friday
Mailing address:
4315 Diplomacy Drive
Anchorage, AK 99508
Physical address:
4141 Ambassador Drive, Ste. 118
Anchorage, AK 99508
Phone: 907-729-3019
Fax: 907-729-3001
Email: akahimroiteam@anthc.org