Release of Information Services

(Obtaining Copies of your Medical Records)

Patient medical records are confidential and shall not be released, nor the information contained therein disclosed, except in accordance with legal requirements and Community Mercy Health Partners policy and procedure.

Requests for Medical Records

  • There is a charge for copies of medical records. Please see the copy fees listed below.
  • Fees are waived for copies sent directly to patient caregivers for continued patient care.
  • Your physician can request your medical record by faxing the request to the numbers listed below.

Release of Information is permitted upon Community Mercy Health Partners obtaining a valid ‘Authorization to Disclose Health Information.’ This form is available in the Health Information Management Departments at the facilities listed below. Or, you may download the form(s) below:

Authorization to Disclose Health Information


If you have any questions on how to complete this form, please contact the respective site medical records department.

Public Hours of Operation
Monday – Friday, 8:00 a.m. – 4:30 p.m. (Springfield Regional Medical Center only)
Monday – Friday, 8:00 a.m. – 4:00 p.m. (Mercy Memorial Hospital only) 
Closed on Holidays

Springfield Regional Medical Center

Attn: Medical Records / ChartOne
100 Medical Center Drive | Springfield, Ohio 45504
937-523-5590 (phone)
937-523-5989 (fax)

Mercy Memorial Hospital

Attn: Medical Records / ChartOne 
904 Scioto Street | Urbana, Ohio 43078
937-484-6161 (phone) 
937-484-6179 (fax)

Signed & completed ‘Authorization to Disclose Health Information’ forms should be submitted to the location from which you are requesting copies of medical records. Authorization forms can be submitted in person or by mail or fax to the respective site. Mailing and fax information for each acute Community Mercy Health Partners facility is listed above.

It is requested that you include a phone number that we can contact you at in case we have any questions regarding your request.

Copies of the medical record (s) requested may be received by mail or picking up from the respective facility during the public hours of operation. Please note that if you are picking up your records, please contact the respective site’s medical record department prior to your arrival to ensure your request has been completed and is ready for pick up. A photo I.D. is required to be presented at the time of pick up.

Usual turnaround time for a request to be completed is within 10 business days from the date of receipt. Additional time may be necessary to process your request if the requested information is located off site or if the authorization to use, disclose or release health information is not properly filled out.

To check the status of your medical records requests, please call the hospital number listed above.

Requests for copies of Birth Certificates should be made to the Ohio Department of Health Vital Statistics or the county health department in which the birth took place.

Please click here for a fee schedule for third party requests of medical records.