Medical Records Requests

How to Request a Copy of Your Medical Records

NOTICE: Our Medical Records office is relocating to an off-site location. As a result of moving off campus, patients will no longer be able to request & receive physical, paper records the same day that they request them. Records can still be emailed or faxed directly to patients. Physical records will be available for pickup after a patient has been notified of their completion in the Main Hospital Lobby with our registration team during normal business hours. We thank you for your understanding of this new process and your patience as our team transitions to their new physical location.

Plumas District Hospital is happy to provide you with a copy of your health information. To request a copy of your records for a provider, please download and fill out the form below:

• AUTORIZACIÓN DE LIBERACIÓN DE INFORMACIÓN (31.15 KB)
• Medical Records Request Authorization Form (243.98 KB)

Please return it to the fax number (Fax: 530-283-7197) or email provided below. (medicalrecords@ksxh.net). You will need to fill out the form completely, with your full name and contact information, birth date, and the specific treatment dates you are seeking. Please include a photocopy of your photo ID. We provide the first request at no cost to you.

Contact Information
Plumas District Hospital
Health Information Management
1065 Bucks Lake Road
Quincy, CA 95971

Phone: 530-283-7122
Fax:530-283-7197
Email to:medicalrecords@ksxh.net

Hours for medical records requests:
Monday - Friday: 8 a.m. to 5 p.m.
Closed on holidays