Kootenai Health makes it easy to require copies of your medical records. Requests can be made by returning this authorization form to medical records in person, via mail, fax, or by email at Kootenai Health – HIM ROI HIMROI@kh.org
When your record is ready, you may pick up it up in person or have it mailed to you. Please bring your photo ID with you when submitting or picking up a medical record request.
If you need to request a medical record for a deceased patient, please contact the medical records department to ensure you have the required paperwork prior to submitting your request.
The medical records office is located in the southeast wing of the first floor the main Kootenai Health building near the gift shop and chapel.
Notice of Privacy Practices:
- Notice of Privacy Practices (Effective April 2, 2018)
Important Forms:
- Birth Certificate Worksheet (PDF)
- IHDE Request to Restrict Disclosure of Health Information (PDF)
- Request for Restriction of Use and Disclosure Form (PDF)
- Patient Request to Amend Protected Health Information (PDF)
- Confidential Communications Request Form (PDF)
- Request for Accounting of Disclosures Form (PDF)
- Privacy Rights Complaint Form (PDF)
- Authorization to Release Information (PDF)
General Information:
Contact Information
Kootenai Health
Medical Records Department
2003 Kootenai Health Way
Coeur d’Alene, ID 83814
(208) 625-6251 phone
(208) 625-6247 fax
