Authorization Forms

Request for Access to Personal Health Records
If you were a patient of Riverside Health Care you can receive a copy of your health records by completing this form and mailing it to the hospital you were treated at.

Consent to Disclose Person Health Information
If you were a patient of Riverside Health Care  you can request that your records be released to a third party by completing this form and mailing it to the hospital you were treated at.

Administrator to Administrator Request Form
This request form can be used by a hospital administrator or a representative of the administrator to obtain copies of a patient’s medical record in order to treat the patient when he/she is deemed incapable of giving consent.

Please Note: There is an administrative cost for non-medical requests. A pre-payment fee must be submitted with your written request. For a list of costs, download the Fact Sheet for Release of Information.