We want to guard your privacy and ensure that your medical records are only seen by you, your healthcare providers and those you may grant consent to.
In order to release your medical records for your use or to a third party you have consented to release your record to, we will need you to complete a Medical Release Form. You can download and print the form below or stop front office and request it. Please make sure you fill out the form completely to ensure accuracy with the medical records being requested and released. Only information specified on the form will be provided.
If you need your records to be sent to Desert Senita, please use this form:
Release with DSCHC Information
If you need Desert Senita to release your records to a company, person, or facility, please use this for:
Release without DSCHC Information
Patients can receive one year of medical records with no charge, more than a year, a fee of $15.00 plus $0.30 per page will be due upon request of medical records.
If a request is made to outside hospitals and specialists, a continuity of care form will be required to be mailed or faxed to our health center.