Medical Records Requests

A patient, or his/her legal representative, may inspect and/or obtain a copy of their medical records, or have copies of medical records sent to another facility.

We require a completed and signed Authorization for Release of Health Information form before releasing any documents to anyone, including the patient.

If you have questions about this process, please feel free to contact the Health Information Management Department directly at 419-557-5552.

To request a copy of your medical records

• Please complete the form Authorization for Release of Medical Information
• Requirements
  • The form must be completed, dated and signed by the patient.
  • We ask that you specify what components of your medical records you wish to obtain.
  • Individuals other than the patient (such as a guardian or a proxy under a power of attorney) must have documentation of authority to sign.
• E-mail your completed form to medicalrecords@firelands.com

Please note: Your request may take up to 30 days to process.

If you have any questions regarding release of health information, please call 419.557.5552.

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