Dardanelle Regional's Health Information Management department is able to assist you in obtaining your medical records. You may deliver a completed request form in-person, by postal mail, or by fax.
How long will it take to receive my medical records?
We are able to complete a request for medical records within 7 to 10 business days after our office receives a request. If your request is delivered in-person, we can often process the request while you are in our office.
Phone number: 479-229-6124
Fax number: 479-229-6176
What information do I need to provide?
Records can be released to anyone that the patient authorizes, in writing. A valid authorization must contain the following information or the request will be returned:
- Patient's full name and date of birth
- Hospital patient ID, if available
- Specific information being requested (e.g., type of report/information and dates of service, etc.)
- Purpose for which the information may be disclosed
- To whom the information is to be sent (name and address)
- Specific authorization's expiration date if desired
- The patient's signature or a patient's legal representative's signature—authorizations signed by a representative must contain a copy of the guardianship papers or power of attorney
- Date of the signature
Medical Records Request Form
Click the link below to download the Medical Records Request form.