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Please describe the records you are requesting and any additional information that will help us locate them for you as quickly as possible. Failure to provide information sufficient to identify the records may cause delay.
If you request medical records for a deceased "Decenent", WA State law (RCW 70.02.140, RCW 7.70.065) identifies a statutory priority among individuals with authority to consent to release a decedent's medical records. Before we can release the records to you, we need to confirm you are eligible.
Support Documentation/ Verification Needed:
By Signing this form, and requesting records for a dependent, the undersigned declares under penalty of perjury of the laws of the State of Washington that the above information and any submitted and attached documentation is true and correct.
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