How to Request Mercy Health Medical Records

Thank you for choosing a 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 Mercy Health facility where you received care, and feel free to call the facility with any questions or if you need assistance completing the forms. If you are unsure of the address or phone number of the location, you can find it in our locations directory.

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.

Medical Record Release Forms

Find the region in which you received care in the list below, then download, complete and return the release form.

Cincinnati, Ohio

You can request a copy of your medical records, or the medical records of someone you have legal representation over, by filling out the form below:

English Form

Spanish Form 

To have records sent to another party (physician, attorney, your spouse or another family member) use this form:

English Form

Spanish Form

Send your request forms to:

Anderson Hospital
Medical Records ROI
7500 State Road
Cincinnati, Ohio 45255
Phone: (513) 732-8388

Clermont Hospital
Medical Records ROI
3000 Hospital Road
Batavia, Ohio 45103
Phone: (513) 732-8731

Fairfield Hospital
Medical Records ROI
3000 Mack Road
Fairfield, Ohio 45014
Phone: (513) 233-6910

The Jewish Hospital - Mercy Health
Medical Records ROI
4777 E. Galbraith Road
Cincinnati, Ohio 45236
Phone: (513) 686-3629

West Hospital
Medical Records ROI
3300 Mercy Health Blvd.
Cincinnati, Ohio 45211
Phone: (513) 215-0735

Irvine, Kentucky

You can request a copy of your medical records, or the medical records of someone you have legal representation over, by filling out the form below:

English Form

Spanish Form 

To have records sent to another party (physician, attorney, your spouse or another family member) use this form:

English Form

Spanish Form 

Send your request forms to:

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

Lima, Ohio

If you would like to request a copy of your medical records click below to fill out our online form:

English Form

If you're looking for a form in Spanish, click the link below to download:

Spanish Form

To have records sent to another party (physician, attorney, your spouse or another family member) use this form:

English Form

Spanish Form 

Send your request forms to:

Mercy Health - St. Rita's Medical Center
Health Information Management
730 W. Market St.
Lima, OH 45801
Phone: (419) 226-9328
Fax: (419) 226-8787

Lorain, Ohio

You can request a copy of your medical records, or the medical records of someone you have legal representation over, by filling out the form below:

English Form

Spanish Form

To have records sent to another party (physician, attorney, your spouse or another family member) use this form:

English Form

Spanish Form

Send your request forms to:

Mercy Regional Medical Center
3700 Kolbe Rd
Lorain, OH 44053
Phone: (440) 960-3320

Mercy Allen Hospital
200 W Lorain St
Oberlin, OH 44074
Phone: (440) 775-4072

Paducah, Kentucky

You can request a copy of your medical records, or the medical records of someone you have legal representation over, by filling out the form below:

English Form

Spanish Form 

To have records sent to another party (physician, attorney, your spouse or another family member) use this form:

English Form

Spanish Form 

Send your request forms to:

Lourdes Hospital
Medical Records
1530 Lone Oak Road
Paducah, KY 42003
Phone: (270) 444-2997
Fax: (270) 444-2920

Springfield, Ohio

You can request a copy of your medical records, or the medical records of someone you have legal representation over, by filling out the form below:

English Form

Spanish Form 

To have records sent to another party (physician, attorney, your spouse or another family member) use this form:

English Form

Spanish Form

Send your request forms to:

Springfield Regional Medical Center
Medical Records
100 Medical Center Drive
Springfield, Ohio 45504
Phone: (937) 523-5393
Fax: (937) 523-5989

Mercy Memorial Hospital
Medical Records
904 Scioto Street
Urbana, Ohio 43078
Phone: (937) 484-6161
Fax: (937) 484-6179

Toledo, Ohio

You can request a copy of your medical records, or the medical records of someone you have legal representation over, by filling out the form below:

English Form

Spanish Form

To have records sent to another party (physician, attorney, your spouse or another family member) use this form:

English Form

Spanish Form

Send your request forms to:

Mercy Health - St. Anne Hospital
CDMC
947 S. Wheeling
Oregon, OH 43616
Phone: (419) 696-5601
Fax: (419) 696-5510

Mercy Health - St. Charles Hospital
CDMC
947 S. Wheeling
Oregon, OH 43616
Phone: (419) 696-5601
Fax: (419) 696-7702

Mercy Health - St. Vincent Medical Center
CDMC
947 S. Wheeling
Oregon, OH 43616
Phone: (419) 696-5601
Fax: (419) 696-5570

Mercy Health - Tiffin Hospital
Health Information
45 St. Lawrence Dr.
Tiffin, OH 44883
Phone: (419) 455-7250
Fax: (419) 455-7257

Mercy Health - Willard Hospital
Health Information
1100 Neal Zick Rd.
Willard, OH 44890
Phone: (419) 964-5050
Fax: (419) 964-5061

Mercy Health - Defiance Hospital
Health Information
1404 East Second St.
Defiance, OH 43512
Phone: (419) 785-3994
Fax: (419) 782-0219

Youngstown, Ohio

You can request a copy of your medical records, or the medical records of someone you have legal representation over, by filling out the form below:

English Form

Spanish Form

To have records sent to another party (physician, attorney, your spouse or another family member) use this form:

English Form

Spanish Form

Send your request forms to:

Mercy Health - St. Elizabeth Youngstown Hospital
Health Information Management
1044 Belmont Ave.
Youngstown, OH 44501
Phone: (330) 480-2710
Fax: (330) 480-2929

Mercy Health - St. Elizabeth Boardman Hospital
Health Information Management
8401 Market St.
Youngstown, OH 44512
Phone: (330) 729-1926
Fax: (330) 729-1927

Mercy Health - St. Joseph Warren Hospital
Health Information Management
667 Eastland Ave.
Warren, OH 44484
Phone: (330) 841-4063
Fax: (330) 841-4255

When will I receive a copy of my medical record?

Please allow 30 business days for us to process your request. In some cases, the information you need may be stored at one of our offsite storage locations so additional time may be required to process your request. Please be sure to fill out the authorization form accurately. Inaccurate information on the form may cause delays in providing you with the information you requested.

Fees

If your request requires a fee, you will be notified of the fee before the record is sent.