The following form provides authorization to release or obtain medical information.
If you are a patient requesting medical records, click the button below to download the form.
Click here to download the Spanish version.
You may get the form to us in one of four ways:
1) Email completed Release of Information request form to
2) Fax completed form to: 870-414-4999
3) Mail completed form to:
North Arkansas Regional Medical Center
Attn: Medical Records Department
620 N Main
Harrison, Arkansas 72601
4) Deliver the completed form in person to the address listed below (please be sure to bring your photo ID):
North Arkansas Regional Medical Center Medical Records Department
620 N Main
Harrison, Arkansas 72601
2nd Floor, New Tower
For questions, please call 870-414-4058.