Patient Health Records

Correctional Health Services (CHS) Health Information Management (HIM) maintains previous and current incarcerated patient health records electronically.



​See below information on how to request health records.

Required Documents to Request Health Records


The following items are required:


  1. Completed Authorization for Release of Health Information form (filled out, signed, and dated by the patient)
  2. Copy of state-issued identification of the requestor

Authorization for Release of Health Information Form


Remember when filling out the Authorization for Release of Health Information form, the following are required:


  • All sections must be completed
  • The patient must fill out, sign, and date the Authorization
  • The Authorization will need to be returned to the Health Information Management staff for processing
  • A copy of state-issued identification of the requestor must be included with the completed Authorization form

Note that only completed documents will be processed.

You can download the Authorization for Release of Health Information form by clicking the link below.

Download Authorization for Release of Health Information Form

*Reminder: ALL sections must be completed

  1. Authorization For Release Of Health Information (English)
  2. Authorization For Release Of Health Information (Spanish)

Submitting Authorization

There are three ways to submit your completed Authorization:
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  1. You may electronically send the Authorization along with a copy of state-issued identification of the requestor to the following email address: CHSHIMROI@Maricopa.gov
  2. You may fax your completed Authorization request, along with a copy of the state-issued identification of the requestor to the following fax number: 602-372-8575
  1. You may mail your completed Authorization along with a copy of state-issued identification of the requestor to: Maricopa County Correctional Health Services
    Attn: Health Information Management
    234 N. Central Ave, Ste 5400, Phoenix, AZ 85004

​​​NOTE:​ You will be notified electronically by automatic response that your request has been received. You will usually be contacted within 7-10 business days. Payment instructions will be included within the fee letter you receive once your request has been approved.​​​
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​Please DO NOT mail or submit payment until notified to do so. You will receive confirmation when your request is approved and you will be notified of the dollar amount required for the service. ​​

FEES

Please ensure your cashier’s check, money order, or business check is made payable to: MARICOPA COUNTY CORRECTIONAL HEALTH SERVICES. Please note that NO PERSONAL CHECKS WILL BE ACCEPTED and that you should NOT submit payment until notified to do so.

  • Electronic records are a flat fee of $6.50 for standard requests for records that are maintained and fulfilled electronically
  • Paper copies are $10.00 for the first 10 pages and $.50 for each additional page
Hours of operation: 
Monday through Friday, 8:00 am to 4:00 pm 
​Closed weekends and holidays

CHS Health Records Contact Number: 602-506-3509