GMHA Medical Records Request
Step 1: Click on this link in red it will take you to the form:AUTHORIZATION FOR USE OR DISCLOSURE OF MEDICAL INFORMATION
Checklist of documentation required in addition to the authorization form:
Steps to request for Medical Records:
1. Complete GMHA Authorization For Use Or Disclosure Of Medical Information form.
2. Provide the following requirements:
a. Government issued picture ID (Passport, Driver’s License or Guam ID) *Must be current, NOT expired.
b. Original Documents
1. Legal Guardianship/POA, Subpoena or Ex Parte Custody Order for Legal Representative.
2. Birth Certificate for Parent’s with different last name.
3. Marriage Certificate or Divorce decree for change of name.
4. Death Certificate for Expired patient.
3. Authorization Form and electronic copies of required documents can be emailed to the GMHA Medical Records Department using the email address below.
4. GMHA Medical Records Department with contact you to coordinate pick-up once your request has been processed, approved, and prepared for pick-up.
Email address: correspondence@gmha.org
Immunization Flow Sheet
- Cannot be sent via email
- Does not require Authorization request form
- Cannot be processed until DPHSS Official Birth Certificate is provided to GMHA Patient Registration so baby's name can be updated in the system.