Your Pediatrics Northwest Records

To request your medical records from Pediatrics Northwest be sent elsewhere (to another provider, yourself, your child’s school, your attorney, etc.),  please print and fill out the below form and either mail, fax, or bring it in to any of our offices.

Send Records to Us From Another Facility

To authorize release of medical records from another facility to our practice, please print and fill out the below form and either mail, fax or bring it in to any of our offices.

How to Submit Request Forms

  • By Mail: Pediatrics Northwest P.S. HIM department, 316 Martin Luther King Jr. Way Suite 212, Tacoma WA, 98405
  • Fax: 253-383-5320 to Pediatrics Northwest P.S. HIM department
  • Or, In-Person: bring the form with you to one of our offices

Personal Copies

There is no fee associated with forwarding the records; however, you will not be given a copy of the records. If you would like a personal copy of your child’s record, the following charges may apply:

  • $1.17 per page for the first 30 pages
  • $0.88 per page thereafter