Medical Records Request

The release of personal medical health records can be obtained by completing the appropriate form(s) below and submitting to your Mercy physician's office or local Mercy Health Information Management office.

• Patient Request: Access to Protected Health Information (PHI): English | en Español
• Third-Party Request: Authorization for Use and Disclosure of Protected Health Information: English | en Español

Additional Patient Forms

• Request for Accounting Disclosures of Protected Health Information: English
• Request for Amendment of PHI: English
• Request for Confidential Communication of PHI: English
• Request for Release Restriction to Insurance Carrier: English

For questions regarding the above forms, please contact your local Health Information Management office:

Health Information Management
1011 14th Avenue NW
Ardmore, OK 73401
580-220-6622

Health Information Management

Berryville, AR 72616

Health Information Management
3125 Dr. Russell Smith Way
Carthage, MO 64836
Phone: 417-359-1850
Fax: 417-237-7221
Email: [email protected]

Health Information Management
7301 Rogers Avenue
Fort Smith, Arkansas 72903
Phone: 479-314-3154

Health Information Management
3462 Hospital Road
Healdton, OK 73438
580-229-1021

Health Information Management
1400 US Highway 61
Festus, MO 63028
Phone: 636-933-1521
Fax: 636-933-5748

Health Information Management
100 Mercy Way
Joplin, MO 64804
Phone: 417-556-2175
Fax: (417) 556-6576
Email: [email protected]

Health Information Management
1000 Kingfisher Hospital Drive
Kingfisher, OK 73750

Health Information Management
100 Hospital Drive
Lebanon, MO 65536
417-533-6051

Health Information Management
1000 E. Cherry Street
Troy, MO 63379
Phone: 636-528-3262
Fax: 636-528-5431

Health Information Management

4300 West Memorial Road

Oklahoma City, OK 73120

Health Information Management
2710 S. Rife Medical Lane
Rogers, AR 72758
Phone: 479-338-2962
Fax: 1-866-427-8729

Health Information Management
4300 West Memorial Road
Oklahoma City, OK 73120

Health Information Management

434 N. West Street

Perryville, MO 63775

Health Information Management

1235 E Cherokee St

Springfield, MO 65804

Health Information Management
10010 Kennerly Road
St. Louis, MO 63128
Phone: 314-525-1239 (select option 2)
Fax: 314-525-1972

Health Information Management
1701 Lacey Street
Cape Girardeau, MO 63701
Phone: 573-651-5534

Health Information Management
615 S. New Ballas Road
St. Louis, MO 63141
Phone: 314-251-4622
Fax: 314-251-4624

Health Information Management
1200 North One Mile Road
Dexter, MO 63841
Phone: 573-614-1952

Health Information Management
1000 S. Byrd St.
Tishomingo, OK 73460
580-371-2327

Health Information Management
901 E. Fifth Street
Washington, MO 63090
Phone: 636-239-8222
Fax: 636-239-8228

Health Information Management

4300 West Memorial Road

Oklahoma City, OK 73120