Request My Medical Records

At this time, our Health Information Management Release of Information area is closed to patients, guests and visitors. We are still available to assist with your medical record needs in other ways.

If you would like to request copies of your records, please download the Request for Information Authorization form below:

You may submit the signed and dated Request for Information Authorization form to us in one of the following ways:

  • Attach the completed Request for Information Authorization document via the electronic request form below, or
  • Fax a signed and dated request to 812-376-5977, or
  • Mail a signed, dated request to Columbus Regional Hospital, Attn. Health Information, 2400 E 17 Street, Columbus, IN 47201

Electronic request form

Select how you would like to receive your records.
Attach signed and dated authorization form

This field is required

This file must be in PDF format.