Kettering Health Network (ketteringhealth.org)
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K For Life Phone Number
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K For Life Phone Number
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Medical Records

Requesting a Copy of Your Medical Record


Your medical record is a PERSONAL, LEGAL, and CONFIDENTIAL DOCUMENT. It contains documentation of the HEALTHCARE SERVICES you received during your visit to the hospital.

Your medical record WILL INCLUDE your health history, physical exams, lab tests, medications prescribed, plan for further care, and nursing notes. Your record WILL NOT CONTAIN your birth certificate or imaging films (such as x-rays).


If you are requesting copies of original birth or death certificates, please contact Montgomery County Vital Statistics, (937) 225-4418.

To obtain copies of imaging films, please contact the appropriate radiology location.


The following people may request a copy of your medical record:
  • You, the patient (not your spouse)
  • Your parent (if you are younger than 18 years of age)
  • Your legal guardian (proof of guardianship document must be provided)
  • Your power of attorney if you are unable to sign (legal documentation must be provided)

Requests for medical records of a deceased person require a completed, signed, and dated authorization, a copy of the death certificate, and one of the following:
  • Proof of kinship
  • Executor of decease's estate
  • Legal representative of the deceased

  • Medical care
  • Disability Supplemental Security Income
  • Legal reasons
  • Insurance
  • Personal reasons

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, or:
  • 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.

There is NO COST when your medical record is requested by:
  • Your physician (requested by calling the Kettering Health Network Release of Information department at (937) 752-2200 or by faxing a request on office letterhead to (937) 522-8444
  • Ohio Department of Job and Family Services
  • Social Security Disabilities benefits (request must include documentation that verifies the filing of a claim)
There is a PREPAID COST when your medical record is requested by:
  • Attorneys
  • Insurance companies
  • Patient (for purposes other than continuity of care)
The cost is based on the number of pages copied.

Charges for Paper copies:
  • $3.02 per page for the first 10 pages
  • $0.63 per page for pages 11-50
  • $0.26 per page for pages 51 and above
Charges for copies on CD:
  • $1.51 per page for the first 10 pages
  • $0.31 per page for pages 11-50
  • $0.13 per page for pages 51 and above
Plus the actual cost of postage.