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Medical Records Release Form

The following forms provide authorization to release or obtain medical information. 

If you are a patient requesting medical records, click here to download the form.

If you are a provider requesting medical records, click here to download the form.

Mail completed form to:

Medical Records Department
Washington Regional Medical Center
3215 N. Northhills Blvd.
Fayetteville, AR  72703

You may also deliver the completed form in person to the department from which you would like to request information.

For questions, call 479.463.1076.