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
- Attestation Regarding a Requested Use or Disclosure of PHI: English
- 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:
