To request a copy of your medical record, complete the authorization form below and return it to Health Information Management. Please allow 7 to 10 business days for processing. If you wish to receive a copy of your medical record by mail, you may be asked to pay a small fee to cover mailing expenses.
Make sure to complete the entire form. An incomplete form will delay the processing of your request.
You can return your completed form by:
- Faxing it to 808.242.2538
- Mailing it to: Maui Memorial Medical Center, 221 Mahalani St., Wailuku, HI 96793, Attn: Health Information Management — Release of Information
If you have questions, please call the Medical Records office at 808.242.2458.