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Medical record form release

PMH Health Information Management Department (Medical Records) is committed to excellent customer service and ensuring access to medical records for our patients and community.

For patients who need their hospital or clinic medical records released to a provider or organization outside of Prosser Memorial Health, or if they need copies for themselves, HIM can provide this service upon receiving a completed Authorization to Obtain or Disclose Health Care Information form.

Please download and complete the form for the clinic your primary care provider is located at or for your hospital visit. You will need to identify whom you would like your records released to.

If the form is not returned in person by the patient, a copy of the patient’s photo identification will be required.

You can either drop it off at the clinic or Hospital Health Information Management department. (you can included fax number and email address as well)


Benton City Clinic

Dermatology Center

Grandview Clinic

Prosser Clinic

Prosser ENT Allergy Clinic

Prosser Memorial Health Hospital

Prosser Specialty Clinic

Prosser Therapy Services

Prosser Women's Health Clinic