Release of Information – Metro Health, Wyoming, MI
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 Health Information Management (Medical Records Department). See the below address for where to pick up your medical records. 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.
If you desire someone else to pick up your medical records, please indicate this on the Authorization Form. A valid authorization MUST contain the following information or the request will be denied:
- 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
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
Health Information Management
5900 Byron Center Ave. SW
Wyoming, MI 49509-0916
Phone #: (616) 252-7010
Fax #: (616) 252-6965
The Health Information Management office is open Monday – Friday 8:00 am – 4:30 pm.
Medical Record Amendment Request
You have a right to request an amendment to your medical record if you believe the information in your chart is incorrect or incomplete. The amendment would include the information that you believe is in error, and your corrections to that information.
For Medical Information:
You can fax, mail, or you can submit it in person at Metro Health Hospital’s Health Information Management (HIM) department (Medical Records).
To change demographic information (name, date of birth, address, etc.) you do not need to use this form. You may request the change by sending us a written request by fax or mail to the address and number above.
Click here for the Medical Record Amendment Request form.