Get Request My Medical Records - Butler Health System

This guide provides a clear and supportive pathway for users looking to complete the Request My Medical Records form from Butler Health System. Follow these instructions to efficiently navigate each section of the form.

Follow the steps to complete your medical records request.

1. Click ‘Get Form’ button to access the medical records request form and open it for editing.
2. In the first section, authorize the specific BHS facilities from which you would like to obtain your records. Ensure to check all applicable boxes such as Butler Memorial Hospital or Primary Care Associates.
3. Provide your full name and date of birth, as well as the name of the person or facility to which the records will be sent. Include contact information such as a phone number and fax number.
4. Indicate the purpose of your record request by selecting the appropriate option from the list provided, including options for medical treatment, insurance, legal reasons, or personal use.
5. Select the format in which you would like to receive your records, choosing between paper copies or electronic media.
6. Specify the types of records you wish to obtain and their corresponding dates of service. Be sure to check all categories that apply to your request.
7. Identify specific information you want to be released by checking all relevant boxes, such as history/physical, discharge summary, or specific types of reports.
8. If applicable, indicate if you do not want to release certain sensitive information, like HIV, mental health, or drug and alcohol treatment records.
9. Sign and date the form. If you are authorized to sign on behalf of the patient, please indicate your status and include your signature.
10. Review the form thoroughly to ensure all necessary sections are completed. Once verified, you can save changes to the form, download it for your records, print it, or share it as needed.

Complete your medical records request online today to ensure your health information is accessible when you need it.