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Medical Records Request

Medical Records Office

To receive copies of your medical record, you must complete an Authorization form:

[English] Authorization for Release of Information (ROI)

[Spanish] Autorización Para Uso y Divulgación de Información de Salud

Mail, fax, or bring your completed Authorization form to:

Mad River Community Hospital
Attn: Medical Records Office
3800 Janes Road
Arcata, CA 95521

Open Monday – Friday 8:30A – 4:30P, closed for lunch from 12-1P
Phone (707) 822-7220 ext. 4142
Fax (707) 822-2366

The Authorization form must be completed in order to be a valid Authorization, if mailing or faxing the form please include a copy of your Photo ID. Forms are good for 1 year.

If you have any questions regarding obtaining copies of medical records, please contact the Medical Records Office at (707) 822-7220 ext 4142

Mad River Community Hospital is committed to protecting your health information Privacy Practices.

Certified copies of Birth Certificates over 2 months old may be obtained from the Office of Vital Records located at 825 5th Street, Eureka, CA 95501. Vital Records shares an office with the County Clerk Recorder Office on the 5th floor of the Courthouse. Please call Vital Records at 707-445-7382 for fee information.

Patient Portal

Upon admission or discharge, you should receive a username and password to access your medical information. If you’re having trouble logging in, call (707) 825-4976 to reset your password. They will send you a new link to get started. Click on the link below to log in.

Patient Portal