Patient or Legal Representative Requesting Copies of Medical Records

To obtain a copy of a medical record from the MetroHealth Medical Center, download, complete, sign, and date the Authorization to Release Protected Health Information to Another Facility  and mail it back to us with a prepayment of $10.00.  Please send check or money order made out to MetroHealth Medical Center.  You will be billed for the balance.  Unsigned and undated requests cannot be processed.

Attorneys and Insurance Companies

To obtain a copy of a medical record from the MetroHealth Medical Center, download, and have the patient complete, sign, and date the Authorization to Release Protected Health Information to Another Facility  and mail it to MetroHealth Medical Center.  You may also use your own authorization for the release of medical information as long as it is HIPAA compliant.  The request must be signed and dated within the past 60 days unless the authorization includes an expiration date.  You will be billed for the copies.  Unsigned and undated requests cannot be processed.

Most requests are processed and fulfilled within ten business days.  Please indicate on the authorization form if you prefer that the copy of the medical record be sent to the address specified on the authorization form, or if you prefer to pick up your copy from our office during business hours.

Forms

Authorization to Release Protected Health Information to Another Facility
This form is for release of medical records related to care provided after 2002 only at the MetroHealth Medical Center (Main Campus), MetroHealth Outpatient Surgery Center, or at the following locations:  MetroHealth Buckeye Health Center, MetroHealth West Park Medical Building, MetroHealth Brooklyn Medical Group, MetroHealth Strongsville Medical Group, MetroHealth Asia Plaza Health Center, MetroHealth Lee-Harvard Health Center, MetroHealth Broadway Health Center,  Thomas F. McCafferty Health Center, J. Glen Smith Health Center.

For copies of medical records from the primary care satellites prior to 2002, please contact the Medical Record Department at MetroHealth Broadway Health Center at 216-957-1883.

If you received care at The Elisabeth Severance Prentiss Center for Skilled Nursing Care at MetroHealth, please call 216-957-8899 to learn how to obtain medical record copies:

Fees

Medical record copies are provided free of charge for healthcare providers.

One free copy of a patient's medical record is provided, on receipt of an appropriate request, for:

The Bureau of Workers' Compensation, The Industrial Commission, The Ohio Department of Job and Family Services, and The Ohio Attorney General

Note:  A patient or patient's legal representative may obtain a free copy of the medical record if the record is necessary to support Social Security disability benefits and the request is accompanied by documentation that a claim has been filed (a patient's personal representative means a minor's parents or other person acting in loco parentis, a court-appointed guardian, or a person with durable power of attorney for health care for a patient, the executor or administrator of the patient's estate or the persons responsible for the patient's estate if it is not to be probated).

The Ohio Department of Health sets the fees hospitals charge for copies of medical records. This can be found in Section 3701.742 of the Ohio Revised Code. These are reviewed and updated annually. The following fees are effective as of January 31, 2012:
 
$2.92 per page for the first 10 pages
$ .61 per page for pages 11-50
$ .25 per page for pages numbering more than 50
 
For a request made by someone other than the patient or patient's representative, hospitals may now charge:
 
An initial fee of $17.97 to compensate for the records search
$1.18 per page for the first 10 pages
$ .61 per page for pages 11-50
$ .25 per page for pages numbering more than 50
 
With respect to data recorded on something other than paper (e.g., x-rays, CDs), the new maximum charge is $2.00 per page. The actual cost of postage may be charged.