Request a paper copy of your hospital medical records

The Health Information Management Department (Medical Records) fulfills requests for photocopies of medical records. This process is often called a "release of information."

There are three ways to request your medical record:

  1. Your doctor can call 574-364-1068 or fax to 574-364-2790 a request for copies of your medical records. All requested copies of records will be sent directly to the doctor's office. There is no charge for this service.
  2. Your attorney can submit a request to have copies of medical records provided to his/her office. This is necessary for the records to be admissible in court. Please note: there is a fee for this service. There may also be an additional Stat fee of $10 if the request requires immediate processing within 24 hours.
  3. You can request copies of medical records for yourself. Please note: there may be a charge to fulfill a direct request. To request your records, please follow the steps in the next section.

To personally request a copy of your medical record, follow these steps:

  1. Download and complete Authorization for the Release of Medical Records Form
  2. Fax or mail your completed form, along with a legible copy of your state issued photo identification*.
  3. If you prefer, you may request your records in person. Bring the completed authorization to the Health Information Management Department (Medical Records) office at Goshen Hospital. Bring photo identification with you.
  4. The Medical Records Colleague will verify your identification* and inform you of the processing charge, if applicable, based on the number of pages requested (see fee schedule below). If your request is not in person, you will be notified of the fee, if applicable, either by telephone or by mail.
  5. You will be notified when the copies are ready for pick up. If there is a fee for the copies, payment must be received prior to release.

*If we are unable to verify your signature with that on file or your photo ID is not legible, we reserve the right to require a notarized signature or resubmission of a legible photo identification.

As outlined by Indiana Administrative Code 760 as of February 2006, the fee for the processing of medical records is as follows:

Labor charges and the first (1-10) pages

$20.00

Per page 11-50

$0.50

Each additional page (50+)

$0.25

Certified Medical Record

$20.00

Expedited Request

$10.00

Postage cost will be added to the above fees for mailed medical records.