UW Neighborhood Clinics
Please note that it may take up to 15 days to process medical records requests.
Release of Information (to Patient) (PDF)
To be used by patients who wish to receive a copy of their own personal records. Please fax the completed form to 206.262.0104*.
Release of Information (to UW Medicine) (PDF)
To be used by patients who wish to have the UW Neighborhood Clinics request records from an outside provider. Please fax or submit the completed form to the non-UW Medicine provider. Please indicate that the records should be sent directly to your UW Neighborhood Clinic.
Release of Information (from UW Medicine) (PDF)
To be used by patients who are asking that the UW Neighborhood Clinics release medical records or health information to a non-UW Medicine provider. Please fax the completed form to 206.262.0104*.
*UW Neighborhood Clinics partner with IOD, a health information management company, to process all medical record requests. If you need assistance regarding forms that you have faxed to IOD at 206.262.0104, please contact their customer service department at 425.462.7771 extension 72.