Patient & Visitor Resources
Requesting Mercy Medical Records
The release of personal medical health records can be obtained by completing the appropriate form(s) below and submitting to your Mercy physician's office or local Mercy Health Information Management office.
- Patient Request: Access to Protected Health Information (PHI): English | en Español
- Third-Party Request: Authorization for Use and Disclosure of Protected Health Information: English | en Español
Additional Patient Forms
- Request for Accounting Disclosures of Protected Health Information: English
- Request for Amendment of PHI: English
- Request for Confidential Communication of PHI: English
- Request for Release Restriction to Insurance Carrier: English
For questions regarding the above forms, please contact your local Health Information Management office:
Fax: 580-421-1384
Email: [email protected]
Health Information Management
1011 14th Avenue NW
Ardmore, OK 73401
580-220-6622
Fax: 580-220-6617
Email: [email protected]
Health Information Management
214 Carter St.
Berryville, AR 72616
Phone: 870-423-5282
Fax: 417-820-7446
Email: [email protected]
Health Information Management
3125 Dr. Russell Smith Way
Carthage, MO 64836
Phone: 417-359-1850
Fax: 417-237-7221
Email: [email protected]
Health Information Management
7301 Rogers Avenue
Fort Smith, Arkansas 72903
Phone: 479-314-3154
Fax: 1-866-427-8729
Email: [email protected]
Health Information Management
3462 Hospital Road
Healdton, OK 73438
580-229-1021
Health Information Management
1400 US Highway 61
Festus, MO 63028
Phone: 636-933-1521
Fax: 636-933-5748
Health Information Management
100 Mercy Way
Joplin, MO 64804
Phone: 417-556-2175
Fax: (417) 556-6576
Email: [email protected]
Health Information Management
1000 Kingfisher Hospital Drive
Kingfisher, OK 73750
405-375-7811
Fax: 405-375-7998
Health Information Management
100 Hospital Drive
Lebanon, MO 65536
417-533-6051
Health Information Management
1000 E. Cherry Street
Troy, MO 63379
Phone: 636-528-3262
Fax: 636-528-5431
Health Information Management
4300 West Memorial Road
Oklahoma City, OK 73120
405-752-3614
Fax: 405-752-3665
Health Information Management
2710 S. Rife Medical Lane
Rogers, AR 72758
Phone: 479-338-2962
Fax: 1-866-427-8729
Email: [email protected]
Health Information Management
4300 West Memorial Road
Oklahoma City, OK 73120
405-752-3614
Fax: 405-752-3665
Health Information Management
434 N. West Street
Perryville, MO 63775
Phone: 573-902-2711
Fax: 573-902-2036
Mercy Hospital Pittsburg
Health Information Management
1 Mt. Carmel Way Pittsburg, KS 66762
(620) 235-3583
Fax: (620) 232-0272
Health Information Management
1235 E Cherokee St
Springfield, MO 65804
Fax: 417-820-7446
Email: [email protected]
Health Information Management
10010 Kennerly Road
St. Louis, MO 63128
Phone: 314-525-1239 (select option 2)
Fax: 314-525-1972
Health Information Management
1701 Lacey Street
Cape Girardeau, MO 63701
Phone: 573-651-5534
Fax: 573-651-5819
Health Information Management
615 S. New Ballas Road
St. Louis, MO 63141
Phone: 314-251-4622
Fax: 314-251-4624
Health Information Management
1200 North One Mile Road
Dexter, MO 63841
Phone: 573-614-1952
Fax: 573-624-6265
Health Information Management
1000 S. Byrd St.
Tishomingo, OK 73460
580-371-2327
Health Information Management
901 E. Fifth Street
Washington, MO 63090
Phone: 636-239-8222
Fax: 636-239-8228
Health Information Management
4300 West Memorial Road
Oklahoma City, OK 73120
405-752-3614
Fax: 405-752-3665
