Medical Records - Health Information Management
Hours of Operation:
Monday through Friday; 7:30 am to 5:30 pm
Release of Information Clerk: (330) 343-3311, ext. 2326
The Health Information Management (Medical Records) office is located on the ground floor of the hospital.
Obtain Copies of Your Medical Records
Patients may obtain copies of their medical records in one of three ways.
- Download and print a copy of the Authorization for Release of Information form.
[click to download the form now]
- Fill out the form
- Sign and date the form
- Make a copy of your photo ID
- Mail the form and copy of ID to:
Health Information Management
Dover, OH 44622
- FAX the form and copy of your photo ID to: (330) 364-0868
- Come to Union Hospital's Health Information Management (Medical Records) office and fill out the Authorization for Relese of Information Form in person.
You must bring a photo ID with you to obtain copies of your medical records.
There will be a charge for copies of your medical records. The fees are in accordance with the Ohio Revised Code. Copying charges are:
- 1 - 10 pages: No charge
- 11 - 20 pages: $2.98 per page
- 21 - 40 pages: $0.62 per page
- 41+ pages: $0.26 per page
The charge for data recorded on something other than paper (e.g., x-rays, CDs) is $1.87 per page/document.