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509.525.3720

Release of Information

The Walla Walla Clinic respects your privacy. We understand that your personal health information is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law allows us to do so.

Processing the release of records is offered when coordinating care between the Walla Walla Clinic and another provider or facility. This process will take no more than 15 days, and there is no processing fee.

To request records from another facility, please:

  1. contact that facility and ask them to fax the records to us at 509.525.6897, or
  2. visit our Walla Walla Clinic Medical Records department at the address below, to fill out a Release of Information request, or
  3. print and completely fill out this Release of Information Form. Note: Some outside facilities may not accept electronic signatures on this form as authorization. If so, you will be contacted to visit the Walla Walla Clinic to provide a physical signature.

Walla Walla Clinic
Attn: Medical Records Department, Building B
55 W. Tietan St
Walla Walla, WA 99362

Fax 509.525.6897

To request we release records to another facility, please:

  1. visit our Walla Walla Clinic Release of Information department at the address below to fill out a Release of Information form, or
  2. print and completely fill out this Release of Information Form, and bring it to the Walla Walla Clinic Release of Information department at the address below. Alternatively you may also mail it to:

Walla Walla Clinic
Attn: Release of Information Department, Building A
55 W. Tietan St.
Walla Walla, WA 99362

To request records for personal use:

If you are requesting records for your personal use, please visit us at the Walla Walla Clinic, Release of Information department, at the address above. The printing of these documents will incur a processing fee. You may also print and completely fill out this Release of Information Form and bring it with you to the Walla Walla Clinic Release of Information department, though please postpone signing the form until you are meeting with our Release of Information Clerk.

Selective records may be obtained from your FollowMyHealth Patient Portal account without visiting the Walla Walla Clinic. If you do not have access to a FollowMyHealth Patient Portal account, please visit any of our check-in desks at the Walla Walla Clinic for more information.

Please feel free to call us with questions at 509.525.3720 ext. 1220, during our normal business hours of Monday-Friday 8:00am – 12:30pm, and 1:30pm – 5:00pm. You may alternatively email questions to the Release of Information Clerk at roi@wallawallaclinic.com, or send a fax to 509.525.6897.

Nondiscrimination

Walla Walla Clinic complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Walla Walla Clinic does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Walla Walla Clinic:

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Provides free language services to people whose primary language is not English, such as:
    • Qualified interpreters
    • Information written in other languages

If you need these services please contact our clinic Interpreter, or Administration, at 509.525.3720.

If you believe that Walla Walla Clinic has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you have the right to file a grievance with:

Walla Walla Clinic Administration
55 W Tietan St.
Walla Walla, WA 99362
509.525.3720, Fax 509.522.1592

You may file a grievance in person, phone, mail or fax. If you need assistance filing a grievance please contact our clinic Interpreter, or Administration at the number above.

You may also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW Room 509F,
HHH Building
Washington, D.C. 20201
1.800.368.1019, 800.537.7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

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