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.
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
For questions about obtaining your hospital records from Adena Regional Medical Center, Adena Greenfield Medical Center, and Adena Pike Medical Center please call 740-779-7640, Monday through Friday (closed holidays), from 8 a.m. to 4:30 p.m.
Requests for release of information can be faxed to 740-779-7059 or 740-779-7769.
Requests for all three hospitals can be mailed to our central office located at:
Adena Regional Medical Center
Medical Records Department
Financial Services Building
110 Vaughn Lane
Chillicothe, Ohio 45601