Medical Records Request

The release of a patient's Protected Health Information requires a completed and signed authorization from the individual patient. Grundy County Memorial Hospital can provide copies of your medical records once a completed authorization form is received by our Medical Records office. For patients under the age of 18, a parent or legal guardian needs to sign the authorization form and complete the parental rights notification.

Completed requests, including proper signature, may be sent:

• via fax
• via US postal mail, to the hospital address

Once your request is completed, the information can be mailed to the address you designate on the authorization form or you may pick up your copy from the hospital's Registration desk. (Entrance #1) Please bring identification with you if you are picking up the documents.

We can provide your information on paper or CD, and there may be a fee based on the type of request

GCMH Medical Records include:  Patient records from visits to the hospital's Lab, Radiology, Surgery, Therapy, Inpatient, and Emergency departments.

If you are seeking records from a provider who sees patients at the GCMH Specialty Clinic, you will need to make your request directly to the physician's office. Please contact Medical Records for more information.

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