Your Medical Records

An authorization form is required when you are requesting copies of medical records or asking that we disclose your health information to 3rd parties. We cannot fulfill medical records requests via email or an online form. The authorization form is not valid if one or more required elements are left blank. Failure to complete all required elements may result in a delay in processing your request.

In some cases there is a charge for medical records.  Adena follows State and Federal guidelines regarding charging a copy fee for medical records, this includes charging attorneys, third party payers and patients for personal copies.  However, there is no charge to patients for records sent to physician offices, hospitals, and other healthcare providers.  

Download our medical records release form.

Learn more about your medical record request.

The federal HIPAA regulations on patient privacy and confidentiality allow you  the right to request that we make amendments to the information in your medical records.  In order to protect the privacy and confidentiality of your protected health information (PHI) and to comply with federal law, your request is to be documented on the “Amendment Request Form” and send to the Director of Health Information Management.  Your request will be processed within 60 days and you will be notified in writing as to the outcome of your request.

Download the Medical Record Amendment form.