CALL TOCA: 602-277-6211

TOCA Medical Records Request

Medical Records Department
P#:  602-512-8448
F#:  602-277-1074



Below you will find the Medical Records Request form. Simply click on the PDF icon, print and fill out the form.

  1. 1. Fill out top portion with your information.
  2. 2. Check 1st box if you would like TOCA to release your records.
  1. .
  1. 3. Check the 2nd box if you would like TOCA to receive your records.
  • 4. Fill out the second portion with the information of the provider/personnel that will be receiving/releasing records.
  • 5. Please sign and date the bottom of the page.
  • 6. Send request to provider you want to release/send records to TOCA.
  • 7. Return by Fax or Email to TOCA for records you want TOCA to release.
  • Record requests from TOCA will normally be processed within 72 hours.