To Request Medical Records:
- Print and fill out this Request Authorization
- Please do NOT email us to request medical records
- Mail or Fax (937) 522-8444 to the Release of Information Department
- OR call to make an appointment
If you would like to review your medical record in person, please call to make an appointment with the Release of Information Department (937) 752-2200. Please note we cannot process a medical
record request without an authorization form containing your signature. Privacy regulations DO NOT
allow us to process a records request via e-mail. Please complete the
, and either fax or mail it to:
Release of Information Department
1 Prestige Place, Suite 540
Miamisburg, OH 45342
We are open from 8am to 4pm
Monday through Friday.
When you come for your appointment, please bring a picture ID. After verification of your identity, you will be asked to complete an authorization form. If your record involved psychiatric care,
in accordance with hospital policy and state law, we will notify your physician and upon physician approval you may review your medical record.
The medical record is the property of Kettering Health Network and may not be removed from the hospital premises. For more info, please view our
frequently asked questions
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