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Release of Information Services

Release of Information Services

(including The Jewish Hospital – Mercy Health)

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 Mercy Health 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 and you do not need to complete an authorization.
  • Your physician can request your medical record by calling the respective facility or by faxing the request on  his or her office letterhead at the numbers listed below.

Mercy Health may release information after obtaining a valid ‘Authorization to Use, Disclose or Release Health Information’ form. 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 Use, Disclose or Release Health Information (English Version)
Autorización para el uso, revelación o divulgación de información de salud (Spanish Version)

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

Public Hours of Operation:
Mon. – Fri., 8:30 a.m. – 4:30 p.m.


Mercy Health – Anderson Hospital
Attn: Medical Records ROI
7500 State Road | Cincinnati, Ohio 45255
513/624-4073 (phone)
513/624-4074 (fax)

Mercy Health – Fairfield Hospital 
Attn: Medical Records ROI
3000 Mack Road | Fairfield, Ohio 45014
513/682-7259 (phone)
513/870-7313 (fax)

Mercy Health - Western Hills Hospital
Attn: Medical Records ROI
3131 Queen City Avenue | Cincinnati, Ohio 45238
513/389-5130 (phone)
513/389-5875 (fax)
Mercy Health – Clermont Hospital
Attn: Medical Records ROI
3000 Hospital Drive | Batavia, Ohio 45103
513/732-8388 (phone)
513/732-8288 (fax)

Mercy Health - Mt. Airy Hospital
Attn: Medical Records ROI
2446 Kipling Avenue | Cincinnati, Ohio 45239
513/853-5219 (phone)
513/853-7869 (fax)

The Jewish Hospital – Mercy Health
Attn: Medical Records
4777 E. Galbraith Road |Cincinnati, Ohio 45236
513/686-5029
Hours: 7:30 a.m. - 4:30 p.m.

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

Please include a phone number that we can contact you at in case an issue is identified while processing your request.

Copies of the medical record(s) requested may be received by mail or picked up from the respective facility during the public hours of operation. Please note that if you are picking up your records, you should 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.

The usual turnaround time  to complete a request is within 10 business days from the date of receipt. It may take longer 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.

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

2011 Medical Record Fee Schedule based on the Ohio Revised code 3701.742



Patients
Retrieval Fee: None
$2.88/pg (1-10 pgs)
.$60/pg (11-50 pgs)
$.24/pg (51+ copies)
actual postage

Attorney, Insurance & Record Service
Retrieval Fee: $17.70
$1.17/pg (1-10 pgs)
$.60/pg (11-50 pgs)
$.24/pg (51+ pgs)
$1.97 other media copies
actual postage

Other Media: data resulting from x-ray, MRI or CAT scan: on paper or film.
The per page rate for any information reproduced from media other than paper is 1.97 + Retrieval Fee

Cancellation Fees for Attorney, Insurance & Record Service
Cancellation Fee: None
Retrieval Fee: $17.70
Shipping Fee: None
Sales Tax: None


Payment:
Make out check to the Mercy Health hospital facility or exact change only.

  • Walk-ins: Customer requesting 30 pages or less can be processed as on-site delivery.
  • Request for medical records are processed in the order they are received and could take 5-10 days to process.
  • MRO will send out a pre-paid invoice and records will be sent once payment has been received.
  • Authorization form must be completed in its entirety and a picture I.D. must be presented.

To check the status of your medical records requests, please call: 1-888-252-4146 Ext. 1 or contact us by email at: requestinformation@mrocorp.com.



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Date Last Modified: 5/10/2012 11:03:06 AM