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WellConnect - Columbus Regional Health

Forms and Documents

Some frequently needed forms and important information are provided below for your convenience. Simply click on the link to download the document.

How do I request a copy of my medical records?

    1. Download the PDF Authorization For Disclosure of Health Information form linked below 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

  1. It may take 48 hours to complete your request after we receive the Authorization Form. You will be asked to show your picture ID. If you have questions or need more information, please call us at 812-376-5656.
  2. If you need copies of your records to be sent to another physician, hospital, or care provider, please call us at 812-376-5656.

Other Forms


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