Patient Information

How to request a paper copy of your hospital medical records

If you are unable to use one of the options for obtaining electronic records, the Health Information Management Department (Medical Records) will help you obtain photocopies of your hopsital medical records. This process is often called a "release of information."

There are three ways to request your medical records

  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 sent to their office. This is necessary for the records to be admissible in court. 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. There may be a charge to fulfill a direct request. To request your records, please follow the steps in the next section.

If you are requesting a copy of your medical records

  1. Download and complete Authorization for the Release of Medical Records Form.
    • Fax or mail the form, along with a legible copy of your state-issued photo identification*. You will be notified of the fee, if applicable, either by phone or email. OR
    • 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. We will verify your identification* and inform you of the processing charge, if applicable, based on the number of pages requested (see fee schedule below).
  2. 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.

Fees for processing paper-copy medical records

All patient requests that are not transfers of care will be processed at $6.50. Others (third party insurance, subpoenas, etc.) will be processed at the rates listed below (as outlined by Indiana Administrative Code 760 as of February 2006).

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