How to Obtain Your Hospital Medical Records

Health Information Management Office

Location: Union Hospital Ground Floor

Hours of Operation:
Monday through Friday: 7:00 am to 5:00 pm

Release of Information Clerk: 330-343-3311, ext. 2326

Sign Up for the Patient Portal

Come to this office or create a Patient Portal account here

You will need:

  • Your Medical Record Number - Obtain from this office
  • Personal E-mail Address on file with Union Hospital
  • Last four numbers of your Social Security Number

How To Obtain Copies of Your Medical Records

Patients may obtain copies of their medical records in one of three ways.

Obtain your medical records online

Online

Download and print a copy of the Authorization for Release of Information form.

  • Click here 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
    Union Hospital
    659 Boulevard
    Dover, OH 44622
Obtain your medical records by fax

By Fax

FAX the form and copy of your photo ID to: 330-364-0868

Obtain your medical records at the Union Hospital Medical Records office

In Person

Come to Union Hospital's Health Information Management (Medical Records) office and fill out the Authorization for Release 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: $3,07 per page
  • 21 - 40 pages: $0.64 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.
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