Medical Record Requests

Effective April 14, 2003, the federal government created the HIPAA law. HIPAA stands for the Health Insurance Portability and Accountability Act. HIPAA requires health care providers to allow you access to your medical records. Under this law, you also have the right to see, get a copy of, and make a request for an amendment (correction) to your medical record. Health care providers are also allowed to charge a reasonable fee for copying records.

AUTHORIZATION FOR RELEASE OF GENERAL MEDICAL RECORDS/FILMS

(Click link above for a printable form)

You can mail or fax us your completed authorization for release of medical records. We can mail back your requested records, but can only fax to other health care facilities.

 
Mail                                                            
Hancock Regional Hospital                                          
Attn: Health Information Services
801 N. State St.
Greenfield, IN 46140
 
Fax
(317) 468.4309
 
For questions or concerns, please contact our office at (317) 468.4407