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 Form
Mail 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
Certain information requires a special authorization covering sensitive information. This includes psychiatric, drug and/or alcohol abuse, HIV/AIDS, and sexual abuse information. Authorizations for sensitive information must specifically refer to the information that is to be released.
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:
| For medical records from: | Mail the Authorization to: |
| Metro Health Hospital 5900 Byron Center Ave. SW Wyoming, MI 49519 |
Metro Health Hospital Medical Records P.O. Box 916 Wyoming, MI 49509-0916 |
| Metro Health Breton 1925 Breton Road SE Grand Rapids, MI 49506 |
Metro Health Breton Medical Records 1925 Breton Road SE Grand Rapids, MI 49506 Phone # (616) 252-4100 Fax # (616) 252-4953 |
| Metro Health Cascade 4300 Cascade Grand Rapids, MI 49546 |
Metro Health Cascade Medical Records 4300 Cascade Grand Rapids, MI 49546 Phone # (616) 252-1500 Fax # (616) 252-1599 |
| Metro Health Comstock Park 4200 North Division Comstock Park, MI 49321 |
Metro Health Comstock Park Medical Records 4200 North Division Comstock Park, MI 49321 Phone # (616) 252-1600 Fax # (616) 252-1666 |
| Metro Health Caledonia 8941 North Rodgers Court Caledonia, MI 49316 |
Metro Health Caledonia Medical Records 8941 North Rodgers Court Caledonia, MI 49316 Phone # (616) 252-5500 TOLL FREE: (877) 244-2865 Fax # (616) 252-5390 |
| Metro Health Cedar Springs 14211 White Creek Road Cedar Springs, MI 49319 |
Metro Health Cedar Springs Medical Records 14211 White Creek Road Cedar Springs, MI 49319 Phone # (616) 252-6320 (616) 696-6320 from Cedar Springs Fax # (616) 696-6360 |
| Metro Health Hudsonville 3912 32nd Ave. Hudsonville, MI 49426 |
Metro Health Hudsonville Medical Records 3912 32nd Ave. Hudsonville, MI 49426 Phone # (616) 252-8700 Fax # (616) 696-6360 |
| Metro Health Jenison 7686 Georgetown Center Drive Jenison, MI 49428 |
Metro Health Jenison Medical Records 7686 Georgetown Center Drive Jenison, MI 49428 Phone # (616) 252-8600 Fax # (616) 252-8660 |
| Metro Health Lowell l2550 West Main Street Lowell, MI 49331 |
Metro Health Lowell Medical Records 2550 West Main Street Lowell, MI 49331 Phone # (616) 252-5600 Fax # (616) 252-5660 |
| Metro Health Rockford 4685 Belding Road Rockford, MI 49341 |
Metro Health Rockford Medical Records 4685 Belding Road Rockford, MI 49341 Phone # (616) 252-3100 Fax # (616) 252-3120 |
| Metro Health Southwest 2215 – 44th Street Wyoming, MI 49509 |
Metro Health Southwest Medical Records 2215 – 44th Street Wyoming, MI 49509 Phone # (616) 252-8300 Fax # (616) 252-8393 |
| Metro Health Wayland 893 East Superior Wayland, MI 49348 |
Metro Health Wayland Medical Records 893 East Superior Wayland, MI 49348 Phone # (269) 792-6263 Fax # (269) 792-6268 |
