Obtain Medical Records
Release of Information
Access to Your Medical Record
As a patient of Metro Health, you have the right to obtain your medical records.Confidentiality of Care
Your medical record will be treated as confidential by all hospital, medical and office staff members. No one may obtain a copy of your record without written consent with the exception of those required by law, transfer of care or third party payor/insurance contract.How to Submit Requests and Receive Record Copies
To request a copy of your medical records, download, print and complete the Metro Health Authorization FormMail or fax your request to the Medical Records Department. Records can be picked up at the Chris and Joan Panopolus Imaging Center or mailed to you. In the event of a medical emergency, records will be faxed directly to a physician or medical facility.
Please note that while most requests can be filled within 14 days of receipt of a release, some requests may require additional time to process.
Records can be released to anyone that the patient authorizes (in writing) to receive such information. A valid authorization MUST contain the following information or the request will be returned:
- Patient's full name and date of birth (list any other names the patient may have had)
- Specific information being requested (e.g. type of report/information) and dates of service
- Purpose for which the information may be disclosed (insurance, disability, personal use)
- To whom the information is to be sent (name and address)
- Specify authorization's expiration date if desired (see ROI form)
- The patient's signature or a patient's legal representative's signature Authorizations signed by a representative must include a copy of the guardianship papers power of attorney, or personal representative documents
- Date of the signature
Fees
There may be a fee for copies of your medical record. Please call the Medical Records Department for current fee information.Contact Information For Requesting Copies of Medical Records:
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For medical records from: |
Mail the Authorization to: |
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Metro Health Hospital Wyoming, MI 49519 |
Metro Health Hospital
Wyoming, MI 49509-0916 |
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Metro Health Breton |
Metro Health Breton |
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Metro Health Cascade |
Metro Health Cascade |
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Metro Health Comstock Park |
Metro Health Comstock Park |
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Metro Health Caledonia |
Metro Health Caledonia |
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Metro Health Cedar Springs |
Metro Health Cedar Springs |
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Metro Health Hudsonville |
Metro Health Hudsonville |
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Metro Health Jenison |
Metro Health Jenison |
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Metro Health Lowell |
Metro Health Lowell |
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Metro Health Rockford |
Metro Health Rockford |
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Metro Health Southwest |
Metro Health Southwest |
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Metro Health Wayland |
Metro Health Wayland |
