Release of Information
To get copies of
YOUR medical record or test results:
- Print out the Release
of Information form
- Complete the form
and sign it
- Bring to Hendrick
Medical Center - Room 6504. We are open Monday through Friday, 8AM to
4:30 PM
- Bring picture ID
that matches the patient name
OR
- Print out the Release of Information
form
- Complete form and
sign it
- Fax the completed
form to 325.670.6503
- Include copy of
ID with matching signature
Note: Copies of the
requested information will be made within 15 days of the request and will
be mailed to you or available for pick-up. If you choose to pick up the
information from Room 6504, please bring matching ID with you.
To have someone else pick up your medical record:
- Print out the Release
of Information form
- Complete the form
and sign it
- Indicate who is
authorized to pick up the information
- The person who
is authorized should bring the completed form to Room 6504. We are open
Monday through Friday, 8AM to 4:30 PM
- The person who
is authorized to pick up the information must have picture ID confirming
their identity
OR
- Print out the Release of Information
form
- Complete the form
and sign it
- Fax the completed
form to 325.670.6503
- Include a copy
of ID with matching signature
Note: Copies of the
requested information will be made within 15 days of the request and will
be mailed to you or available for pick-up. If you choose to have someone
pick up the information from Room 6504, please have them bring ID to confirm
they are the authorized recipient.
Please contact Hendrick
Health Information Services, for more information.
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