Request Medical Records

Health Information Request

St. Mary’s Health Information Management (HIM) Department has trained professionals that manage your patient health information and medical record. They are committed to the timely and accurate collection of health information and its storage, retention, and disclosure. HIM professionals ensure your information is kept private, secure, and is in accordance with federal and state regulations.

Frequently asked questions and answers are listed below for your convenience. If you have any further questions, please contact us.

Frequently Asked Questions:

Q: How can I obtain a copy of my medical record?

A: You can download the “Authorization for Use of Disclosure of Protected Health Information” form (see .pdf form at right margin) or you may write a letter authorizing the Health Information Management Department to release a copy of your medical record. Both the authorization form/letter must state your name, date of birth, social security number, date of service, name of hospital where services were performed, the person/organization to receive the information, along with the address where the information is to be sent. The authorization form/letter must be signed and dated by the patient or the patient’s guardian/legal representative.

Q: Where do I send the authorization form/letter to release a copy of my medical record?

A: You can mail or fax the authorization form/letter to our central location:

St. Mary’s Medical Center
Health Information Management Department
3700 Washington Avenue
Evansville, Indiana 47750
Fax 812.485.7609

Q: Is there a cost to obtain a copy of my medical record?

A: Yes, there is a charge according to the number of pages reproduced and source of data, such as computer, microfiche or paper. If applicable, a retrieval and postage fee will be applied. Arrangements may be made for you to pick up your medical record copies by calling the Correspondence Department at 812.485.4211, or your copies can be mailed at your request.

Q: I am going to another healthcare provider and would like my records sent to this physician. What do I need to do?

A: You will need to submit a written authorization form/letter to have your medical record copies mailed or faxed to that provider free of charge. You will need to include the name, address and/or fax number of the healthcare provider. There is no charge for copies of your medical record for continuity of care.

Radiology Images, Telemetry Tapes or photos are not part of your medical record. You will need to contact the department that provided the service to receive a copy of that data. The Radiology Film Library phone number is 812.485.4598.

Your medical records do not contain Billing Statements, our Patient Financial Services Department can provide you with this information. Please refer to the Patient Financial Services page on our website to get an on-line summary of your account, submit billing questions, or make on-line payments.

Q: How soon can I expect the release of my medical record?

A: Pending the location of the medical record (computer, microfiche or paper), you can expect a 5 – 7 day turnaround time for the request to be completed. There may be circumstances when the medical record will require immediate disclosure. If this is your situation, please call the HIM Department to discuss your needs 812.485.4211. 

Q: May I get a copy of a family member’s medical record?

A: Only the patient may release his/her record(s). However, if you have Power of Attorney (POA), or you are the executor of the patient’s estate, you must submit your authorization form/letter along with a copy of the legal document, designating POA or executor rights.

Q: Do you release any information verbally?

A: The only information the HIM Department releases verbally is the patient’s date of admission and/or date of discharge.

Q: I would like to know my blood type. Is this information in my medical record?

A: Blood typing is not routinely performed. If blood typing was done, the HIM Department requires a signed authorization form/letter from the patient and a copy of the results will be sent to you. There will be a charge for the reproducing and mailing of this document.

Q: I was born at St. Mary’s Medical Center. How can I obtain my birth certificate?

A: You will need to request the birth certificate from the Vanderburgh County Health Department. You may reach them at 812.435.5681.

Q: How long do you keep a medical record?

A: Medical Records are maintained according to Indiana Statute for various periods of time. You will be contacted if your medical record request cannot be fulfilled due to expiration of the retention period.

Q: Am I able to view my record?

A: Yes, you are able to view your medical record:

  • A valid authorization for release of information is required. The authorization form/letter must be in writing, signed and dated by a physician.
  • Photo identification is required.
  • Contact the Health Information Management Department at 812.485.4211 to schedule an appointment to view your records.
  • There is no charge for viewing the records.

Please note: Your medical records do not contain Billing statements. Our Patient Financial Services Department manages that information. You may submit billing questions or make on-line payments through the Pay Your Bill link on this website.

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