To access, review, or obtain a copy of your medical record, call 330-253-3100 and press option 4, or email email@example.com
Please know that patient confidentiality is a cornerstone of what we do, and we take it very seriously. For that reason, it can take some time to release a medical record, as we need to make sure everything is in order.
To begin the process of requesting your record, you (or in certain cases your authorized representative) must complete and sign an Authorization for Release of Information form. This form needs to be filled out completely, and must indicate the specific contents of the record that you wish to access/review/obtain, as well as the date(s) of service.
Click below to open a PDF of our Release of Information Form. You can print it, fill it out, and return it to us:
There is no charge to access or review your medical record. There is a charge to obtain a copy of your medical record. This charge is to cover the costs of preparing, copying, and mailing the record to you. We will inform you of how much this costs before preparing the record. Once you agree to have your record prepared, payment is due before the record is prepared.
We will notify you (or your authorized representative) in writing within 30 days of your request (60 days if the record is not maintained on-site – this happens as some older records are placed in secure storage), if and when the record will be available, and details on how to follow up.