Request Medical Records
For those who wish to have a copy of their personal records or to have a copy forwarded to a physician or a health-care facility, please submit request to:
Medical Records
Indiana University Health Center
600 N. Jordan Ave.
Bloomington, IN 47405
Fax#: 812-855-4245
Phone#: 812-855-4970
We regret that we cannot accept requests for copies of medical record information by e-mail.
IMPORTANT: There is no charge for medical record copies if they are sent to another Health care provider for continued care. However, there IS a charge if the records are sent for any other purpose, i.e., employment, clinicals or individual use. There is a different charge for U.S. Mail and for faxing records. For details contact Katy Abel, RHIT, Medical Records, 812-855-4970.
Request should include:
Full legal name and Social Security Number or Student Identification Number. (Include your name while enrolled at Indiana University if different)
What part of record you want (be specific: per date(s); type of problem) and the purpose for the release. If you want the entire record please write, "I want entire record that will include everything done in the medical clinic at the Indiana University Health Center."
List the complete address for where to send records and telephone number. If records are to be faxed, please include the fax number.
Include your phone number and a billing address.
Sign (written signature) and date to validate.
Click HERE for a form that may be printed and used as a request for a copy of your Medical Records. |
