Please complete the attached authorization form and return it to: Health Information Management to process your request for medical information.
Please complete the entire form. If form is incomplete it will delay processing of your request. Completion time for processing requests is 7 - 10 business days.
You may return your completed form in the following ways:
- Drop off in person directly to Health Information Mangement (Medical Records) located next to the ER between the hours of 7:00am - 10:00pm, 7 days a week
- FAX: (808) 242-2538
- Mail to: Maui Memorial Medical Center, 221 Mahalani Street, Wailuku, HI 96793, Attn: Health Information Management - Release of Information
Feel free to contact our office with any questions by email or phone at (808) 242-2458.
Authorization for Use and Disclosure of Health Information.pdf.