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How to Request of Copy of Your Medical Records

To obtain a copy or request that your health information (medical records) be sent to another health care facility/provider, insurance companies, attorneys, or another individual, etc., you must first submit a completed, signed and dated authorization form to us. Please be advised that health information such as psychiatric, sexually transmitted diseases, HIV test results and related information, genetic, substance/domestic abuse, and sexual assault treatment records, etc. are considered sensitive information and are further protected by Federal laws. Therefore, if you would like such information to be released, you must specifically indicate so on our authorization form by initialing the respective category of information.

Request Medical Records – Authorization Form (PDF)

Please hand-deliver your completed authorization form or mail the form to us. Our contact information is always located on the top of our forms and shown below.

Medical Records Contact Information

Call 270-932-4211 ext. 224
Business Hours: Monday-Friday, 7:00 a.m. to 4:00 p.m.

You may mail, fax or hand-deliver your authorization to:

Åܹ·ÂÛ̳ Hospital
Medical Records Department
202 Milby Street
Greensburg, KY 42743
Fax: 270-932-9093