Request My Medical Records

How do I request a copy of my medical records?


Download the PDF Authorization For Disclosure of Health Information form on our Medical Records, Forms and Documents page and complete. Then, either fax the completed form and a copy of your picture ID to 812-376-5977, or mail the completed form along with a copy of your picture ID to:

Columbus Regional Hospital
Attn: Health Information
2400 E. 17th Street
Columbus, IN 47201

More Information


Our Medical Records, Forms and Documents page also contains information about the cost of obtaining your records and who is authorized to receive them. If you still have questions about how to attain your medical records, please fill out the form below. Please provide the needed contact information in order for a response to be returned in a timely manner.