You may request a copy of your medical record by completing and submitting an authorization form. A picture ID is required at the time of the request.
The authorization form can be obtained here
- In person at the Release of Information department located at the address below from 8am - 4pm, Mon - Fri.
1 Prestige Place, Suite 540
Miamisburg, OH 45342
- By phone - (937) 752-2200
If your form was obtained here, please fax to (937) 522-8444.
Please allow 10 business days to process your request. If the requested information is located off-site or the authorization form is not properly filled
out, additional time may be required to process your request.
If your request requires a fee, you will be notified of the fee before the record is sent.