MyChart Login

Requesting Medical Records

At times, you might need to request your child’s medical records. Our Health Information Management team can assist you with copying any records you need.

If you want to send the copy directly to another provider, please print and complete the form below and deliver it to our office:

Records Request to Another Provider


For authorization to disclose health care information to Pediatrics Northwest, please print and complete the form below and deliver it to our office:

Release of Records to Pediatrics Northwest


Medical Record Fees

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 (effective 9/7/2017):

  • $26.00 clerical searching and handling fee, plus
  • $1.17 per page for the first 30 pages
  • $0.88 per page thereafter