How to Request a Copy of Your Medical Records


Plumas District Hospital is happy to provide you with a copy of your health information.  To request a copy of your records, please fill out the:


>>Medical Records Request Authorization form


and return it to the fax number or email provided below. (This contact information is also listed on the form). You will need to fill out the form completely, with your full name and contact information, birth date, and the specific treatment dates you are seeking. Please include a photocopy of your photo ID. We provide the first request at no cost to you.


Our staff will contact you regarding receipt of your request, expected turnaround time and payment due. For security purposes, at the time records are delivered to you, you will need to provide proper identification.


If you are requesting more than 20 pages, the following fee schedule based on California state law, will be used to determine the charges:

  • 0.10 cents per page for 8.5x14 inches or less

  • 0.20 cents per page for microfilm

  • Actual costs for the reproduction of oversize documents or the reproduction of documents requiring special process which are made in response to a subpoena

  • The reasonable cost of clerical costs incurred in locating and making records available

  • Actual postage charges

For requests pursuant to Evidence Code Section 1158, please use the following:


>>Authorization For Disclosure of Health Information


and return it to the fax or email provided below.  The above charges apply: 


Contact Information

Plumas District Hospital

Health Information Management
1065 Bucks Lake Road

Quincy, CA 95971


Phone: 530-283-7122
Fax: 530-283-7197

Email to


Hours for medical records requests:
Monday - Friday: 8 a.m. to 5 p.m.
Closed on holidays

















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