Thank you for choosing a Marcum and Wallace, Mercy Health facility to receive your medical care. If you find that you need access to or a copy of your medical records, please print and complete the appropriate form found at the bottom of this page. Mail the completed form to the Marcum and Wallace, Mercy Health facility where you received the service at the address listed.

If you need help to fill-out the release form, or to speak to someone regarding your request, or to set an appointment time to view your records, please use the hospital contact numbers listed below.

Records are kept off site so please allow time for processing. A picture ID is required when picking up medical records. If you select to have your medical records mailed to your home or to another location, a copy of your photo ID must be included with the mailed or faxed request.


Marcum and Wallace Memorial Hospital
60 Mercy Court
Irvine, KY 40336
W:606-726-2157
Fax: 606-723-2250

 


Authorization/Request Forms
Mercy maintains adult medical records for 10 years from the date of service. Records for Minors are maintained until Age 20, but at least for 10 years.  To request copies of your personal medical records or the records of someone you have legal representation over, i.e. Minor Child, Guardian, POA, Executor of the Estate, Surviving Spouse, etc. use this form:

English Request to Access


To have records sent to another party, i.e.physician, attorney, your spouse or another family member, use this form:

English Authorization to Disclose