Medical Records

Requesting Medical records for Coordination of Care

Upon request, we will send pertinent records to your physician for coordination of care at no charge. Pertinent records include:

  • Discharge Summary
  • Discharge Order
  • Psychiatric Evaluation
  • History and Physical Exam
  • Discharge Plan
  • Labs/ Radiology / EKG
  • Consultations Report

All Other Request for Medical Records

  • A copy fee will be charged for copies if the number of pages exceeds 10 pages.
  • The fee for copies is $.25 a page plus postage.
  • If the records requested are in off-site storage, the charge will be at a higher rate.
  • Request of medical records will be processed with in four business days.

Completing the Medical Records Release Form

To avoid delay in processing your records request, the Release of Information Form, must be filled out completely.

  • Please sign and date under Signature of Patient when the patient is requesting the records. Please provide proof of your identification with a valid, government issued ID.
  • If records are being requested by someone other than the patient, please provide proper documentation proving the right to patient’s medical records such as a Medical Power of Attorney, guardianship, etc. The person listed in these documents must sign and date under Signature of Representative.

Medical Records contact information:

Quail Run Behavioral Health
Medical Records Department
2545 W Quail Ave
Phoenix, AZ 85027

Phone Number:  602-455-5711
Fax Number: 602-283-7735

Download Release of Information Form