Patient Forms

Request Medical Records

Ko’olauloa Health Center patients may request a copy of their medical records. Please complete all sections and submit the Consent to Release Confidential Information from KHC form. Please note, that you and a witness must sign the form or we will not be able to process your request. Completed forms may be submitted in person or by fax to 356-3499 or emailed to [email protected]

The request may take up to 30 days to fulfill. Requests for electronic records may take up to 7 days to fulfill. If you are requesting medical and behavioral health records, separate forms must be used.