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.
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
Metro Health Hospital Medical Records
5900 Byron Center Ave. SW
Wyoming, MI 49509-0916
Phone #: (616) 252-7010
Fax #: (616) 252-6965