There are four ways to submit your completed Authorization:
You may upload the completed Authorization along with a copy of state issued identification of the requestor on the CHS Web Form (click here or link below).
You may electronically send the Authorization along with a copy of state issued identification of the requestor to the following email address: chshimroi@Maricopa.gov
You may fax your completed Authorization request, along with a copy of the state issued identification of the requestor to the following fax number 602-253-4931.
You may mail your completed Authorization along with a copy of state issued identification of the requestor to: Maricopa County Correctional Health Services Attn: Health Information Management 201 S 4th Avenue, Phoenix, AZ 85003
NOTE: You will be notified electronically by automatic response that your request has been received. Generally, within 7-10 business days you will be contacted. Payment instructions will be included within the fee letter you receive once your request has been approved. Click here to complete the CHS Web Form.
Insure your cashier’s check, money order or business check is made payable to MARICOPA COUNTY CORRECTIONAL HEALTH SERVICES. NO PERSONAL CHECKS WILL BE ACCEPTED
Electronic records are a flat fee of $6.50 for standard requests for records that are maintained and fulfilled electronically
Paper copies are $10.00 for the first 10 pages and $.50 for each additional page
Hours of operation: Monday through Friday, 8:00 am to 4:00 pm. Closed weekends and holidays