Health Information Management
Cody Regional Health’s Health Information Management Department is
committed to providing optimum customer service to every patient, family
and health care professional. The Health Information Management Department
will maintain the confidentiality of all protected health information,
ensure records are properly secured, and appropriately disclose information
in accordance with federal and state regulations.
Guidelines for Medical Records Requests
All requests for copies of medical records must be received in writing.
If the patient is a minor (younger than 18 years of age), a parent or
legal guardian must sign the authorization (release of information form
below). Urgent patient-care requests may be faxed to
Step 1: Download and Fill Out the Form
Download a Release of Information Form
We are happy to help you request copies of health records. To successfully
request health records, you must download and properly complete an authorization
form. After we receive your completed form, we can release your medical records.
Step 2: Make Sure Your Form is Correct and Complete
To ensure your request is correct and complete we provided the following
tips to help you properly complete your form:
- Full name, including previously used names of the patient you want records on,
- Full Address of patient,
- Date of birth of patient.
Additional necessary information:
- The information and date(s) of service you want released.
- How much information: Pertinent records may include a discharge summary,
history and physical, test results, an emergency department report, and
any consultations; all records include all vitals and large amounts of
- The reason you want the information released.
- Instructions on whether you want to pick-up the information or the appropriate
- The date of your request.
- The patient’s signature.
If the patient is unable to sign the request form due to a physical or
mental disability, a guardian or court-named personal representative may
sign for the patient. If the patient has no guardian or personal representative,
the individual with medical power of attorney may sign for the patient.
You must provide appropriate legal documentation with the request form
if the patient is unable to provide their own signature.
We do not accept digital signatures at this time.
What You Can Request
While we can provide medical information and records, we cannot provide
copies of birth certificates. For a copy of a birth certificate, please contact
Wyoming Vital Records at307.777.7591 or click the link provided.
Step 3: Submit Your Request Form
You can send your request to us through fax, mail, email, or in person.
If you email the form, it must be attached as a scanned document.
Fax: 307-578-2788 or 307-578-2789
West Park Hospital District
Health Information Management Department
707 Sheridan Avenue
Cody, Wyoming 82414
Please note, that when you are sending your information to us by email,
there is some level of risk that the information in the e-mail could be
read by a third party. If you can encrypt the document prior to attaching
it to the email, you can then call to let us know the password at 307-578-2270.
Hours of Operation:
M-F; 7:00 a.m. to 4:30 p.m.
Please contact us if you have any additional questions or need further
- We will fulfill your medical records request within 7-10 business days,
and we will inform you if we experience an unexpected delay.
- All requests for copies of medical records must be received in writing.
- Photo ID is required to release records.
- Individuals may not pick up records for their spouse or adult children
over age 18 unless the proper authorization has been previously submitted.
- If the patient is a minor (younger than 18 years of age), a parent or legal
guardian must sign the authorization (release of information form below).
- We may apply fees or charges in accordance with Cody Regional Health policies,
but we will notify you of any applicable fees before we process your request
Birth Certificate Copies
Copies of birth certificates must be requested through Wyoming Vital Records at
There may be a fee for obtaining your protected health information from
Cody Regional Health
Except when requested by a physician's office or in an emergency, records
will be mailed. You may mail your completed authorization form to Cody
Regional Health or fax it to our Health Information Management staff at
307.578.2288. Your records will be ready in approximately four to seven working days.
If you wish to pick up your records, write "will pick up" in
the lower left corner of the form. We will call you when they are ready.
Keep in mind, we will ask for a photo identification before we release