Medical Record Request
Patient or Personal Representative
Thank you for visiting our website. Our goal for this website is to provide you with some basic information for submitting a request for medical records. To receive more information, please click on the applicable link.
It’s best for the requestor to know the location where the patient received care from, so that the request can be submitted to the correct facility. Knowing the right facility will assist us with providing you with medical information from the facility where the patient received care. For facility locations, please click here.
Patients or their personal representatives can request to access health information by either submitting a request in person, by mail, or via fax to the site where they received medical care.
When submitting a request, it is also important to submit the correct form when placing a request for medical records. Below you will find some information on our most commonly used forms with a brief description of the forms purpose.
ACCESS TO PROTECTED HEALTH INFORMATION
This form can be used when a patient or their personal representative is requesting to receive copies or access the legal medical record from the site where the patient received care. To print this form, please click here.
AUTHORIZATION TO USE AND DISCLOSE PROTECTED HEALTH INFORMATION
This form can be used when a patient or their personal representative wants to give permission for their protected health information to be released to another person or location. To print this form, please click here.
If the request is sent by mail, we will need to verify the applicants identity and authority to request the information, so we recommend sending in a copy of a government issue identification card with the request. Note: you don’t have to reveal the identity card numbers when submitting your request.
As per applicable law, there may be a fee for obtaining medical records. Fees are:
- Up to $0.25 per page copied on paper
- Up to $6.00 for records placed on compact disc
- Up to $0.50 per page for records that are copied from microfilm
- $15.00 flat fee if the records are delivered to an attorney or the attorney’s representative for inspection or photocopying at the record custodian’s place of business
- Copy fees may be waived if the request is for relevant portions of a patient’s record to support an appeal regarding eligibility for a public benefit program. A written request and proof that the records are needed to support the appeal are required to waive the fee.
An invoice may be sent to the requestor if the request requires payment.
Medical Record Request Processing Timeframes
Patient or patient representative request for medical record are usually processed within 15 days after we receive a complete and accurate written request.
In the event where a request for medical records is incomplete or incorrectly completed, the request may be rejected. We will try our best to notify the requestor of the rejection in a timely manner.
We hope that this information helped you understand more about medical record request. If you need further assistance, please use the patient information tools that are located to the left of this page or contact your local Health Information Management office.
- Your HIPAA Privacy Rights
- Get more information on our online patient portal “MyWellness”