CHI Memorials (MHCS) can provide you with a copy of your health information. Such documents may include:
- Notes and records associated with a particular condition
- Handwritten or dictated notes for the treatment dates you request
- Surgical reports
- History and physical reports
- Discharge summary reports
- Lab reports
- Radiology reports
- Pathology reports
- Physical occupational or speech therapy notes
- Reports from other specialized tests, such as cardiac catheterization, stress tests, EEG, EKG, MRI, CT, EMG, etc.
To request a copy of your medical information, please complete the MHCS Authorization to Release Patient Health Information form below. We will need the following information in order to process your request:
- Personal identification (photo ID) to verify that you are the patient (or legally authorized representative entitled to the release of information.
- Name and birth date
- Name of provider or organization authorized to release the information (MHCS)
- Name of the person or organization to whom MHCS may release the information
- Description of specific information to be released
- Purpose or need for the information
- Signature of the individual (patient or legally authorized representative) and date
Please print the MHCS Authorization to Release Patient Health Information form and either bring it to the CHI Memorial Medical Records Department (on the 1st floor of Memorial Hospital) or mail it to:
Health Information Services/Release of Information
2525 de Sales Avenue
Chattanooga, TN 37404
You may send your request by fax to (423) 495-4740. CHI Memorial Medical Records office hours are Monday-Friday from 8:00 a.m. until 4:30 p.m. at the Memorial Hospital Glenwood Campus. Records are usually available within 7 to 10 business days from the time the request is made. If you have any questions, you may call us at (423) 495-8285.
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