Resources & Forms
Find commonly requested forms, medical records information, financial assistance resources, and important notices.
Medical Records
Request or Transfer Your Medical Records
Whether you need a copy of your medical records for personal use or would like records sent to another healthcare provider, our Health Information Management team is here to help.
Use the Medical Records Authorization Form below to request records from any Power County Hospital District facility or authorize records to be sent to us.
Before You Submit Your Request
Please keep the following in mind:
-Complete all required sections of the authorization form.
-Sign and date your request.
-Specify which records you are requesting.
-Choose how you would like to receive your records (mail, email, fax, disc, or pick-up).
Additional identification may be required before records can be released.
Frequently Asked Questions
How do I request my medical records?
Download and complete the Medical Records Authorization Form, then return it to Medical Records (HIM) using one of the approved submission methods.
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Yes. If someone other than the patient signs the authorization, they must indicate their legal relationship or authority to act on the patient's behalf.
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The authorization remains valid for six months from the date it is signed unless revoked earlier in writing.
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Yes. You may request specific portions of your medical record or authorize the release of your complete record.
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208-226-3200 ext. 227
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Notice to Patients
PCHD is committed to treating all patients equitably with dignity, respect, compassion, and professionalism. A Sliding Fee Scale (SFS) discount for clinic visits, emergency and ancillary services and for non-emergency lab and x-ray services may be available. Eligibility for the SFS discount depends solely upon family size and income. The SFS discount is applied in a non-discriminatory, equitable, and uniform manner: 1) regardless of the ability to pay; 2) regardless of participation in Medicare, Medicaid, or CHIP programs; and 3) without regard to race, color, sex, creed, religion, national origin, gender identity, age, physical or mental disability, sexual orientation, citizenship, political belief, marital or family status, pregnancy, veteran status, economic status, or any other legally protected status or assets held. Applications for the discount program are available at facility Admission areas, Business Office, or Hospital Nurse’s station. *Applying for the discount does not guarantee eligibility.
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Aviso a los pacientes
PCHD se compromete a tratar a todos los pacientes de manera equitativa, con dignidad, respeto, compasión, y profesionalismo. Puede haber un descuento disponible de la escala de tarifa (SFS) para visitas a clínicas, servicios de emergencia y servicios auxiliares y para servicios de laboratorio y radiografías que no sean de emergencia. La elegibilidad para el descuento SFS depende únicamente del tamaño de la familia y los ingresos. El descuento SFS se aplica de manera no discriminatoria, equitativa y uniforme: 1.) independientemente de la capacidad de pago; 2.) independientemente de la participación en los programas de Medicare, Medicaid, o CHIP; y 3.) sin distinción de raza, color, sexo, y credo, religión, origen nacional, identidad de género, edad, discapacidad física, o mental, orientación sexual, ciudadanía, creencias políticas, estado civil o familiar, embarazo, estado de económico, o cualquier otro estado legalmente protegido o bienes.
Questions About Financial Assistance?
If you think you may qualify or need help completing, or to pick up an application, please contact Admissions or the Family Clinic at:
Admissions Hospital: 208-226-3200
Family Clinic: 208-226-1057
Financial Assistance
Sliding Fee Scale Program
Power County Hospital District believes that everyone deserves access to quality healthcare. Eligible patients may qualify for discounted charges through our Sliding Fee Scale Program based on household income and family size.
The program may be available for eligible:
Clinic visits
Emergency services
Ancillary services
Non-emergency laboratory services
Non-emergency imaging services
Applications are available at hospital admissions, the Business Office, and the nurses' station.
Please note: Applying for financial assistance does not guarantee eligibility.
Advanced Directives
Power County Hospital District is committed to protecting the privacy and confidentiality of your health information. Our Notice of Privacy Practices explains how your medical information may be used and disclosed, your privacy rights, and how to request access to your records.
Patient Rights
Our Commitment to You
At Power County Hospital District, we are committed to providing compassionate, respectful, and high-quality healthcare. We believe every patient deserves to be treated with dignity while actively participating in decisions about their care.
As a patient, you have important rights and responsibilities that help us work together to provide safe, effective, and personalized care.
Your Rights
Respect and Dignity
You have the right to receive respectful, compassionate, and considerate care in a safe environment without discrimination.
Participation in Your Care
You have the right to participate in decisions regarding your care, ask questions, and make informed choices about treatment options.
Clear Communication
You have the right to receive information about your diagnosis, treatment options, risks, benefits, and expected outcomes in a way you can understand. Interpreter and communication assistance services are available when needed.
Privacy and Confidentiality
You have the right to expect that your medical information will be kept private and protected in accordance with applicable privacy laws.
Family and Visitors
You have the right to choose who may visit you and who may participate in your care, subject to reasonable clinical or safety restrictions.
Voice Concerns
You have the right to ask questions, express concerns, and file a complaint regarding your care without fear of retaliation.
Your Responsibilities
Provide Accurate Information
Provide complete and accurate information regarding your health history, medications, allergies, insurance coverage, and any changes to your health.
Follow Your Care Plan
Ask questions if you do not understand your treatment plan and work with your healthcare team to follow agreed-upon recommendations.
Be Respectful
Treat healthcare providers, staff, patients, and visitors with courtesy and respect.
Keep Appointments
Arrive on time for scheduled appointments and notify us as soon as possible if you need to cancel or reschedule.
Understand Financial Responsibilities
Provide current insurance information and work with our Business Office regarding payment or financial assistance if needed.
Our Promise
Every patient deserves compassionate, respectful, and high-quality care. We are honored to serve our community and are committed to providing a safe, welcoming environment for patients, families, and visitors.
Questions or Concerns?
If you have questions about your rights or responsibilities, or if you have concerns about your care, we encourage you to speak with a member of your care team or contact Administration.
Power County Hospital District
510 Roosevelt Street
American Falls, ID 83211
Phone: 208-226-3200
Patient Rights
Power County Hospital District is committed to protecting the privacy and confidentiality of your health information. Our Notice of Privacy Practices explains how your medical information may be used and disclosed, your privacy rights, and how to request access to your records.