Request My Medical Records

Need your records? It's easier with MyChart!

If you would like to request copies of your records, you can access and make requests via MyChart

The application keeps all of your information including appointments, messages, and records at your fingertips.

If you prefer, you can instead download the Request for Information Authorization form below:

You may submit the signed and dated Request for Information Authorization form to us in one of the following ways:

Attach the completed Request for Information Authorization document via the electronic request form below, or
Fax a signed and dated request to 812-376-5977, or
Mail a signed, dated request to Columbus Regional Hospital, Attn. Health Information, 2400 E 17 Street, Columbus, IN 47201
Patients and representatives can also request copies of medical records in person at the Columbus Regional Hospital medical records desk near patient registration at Entrance 3.

First Name

Last Name

Email address

Street Address or PO Box

City

State

ZIP

Select how you would like to receive your records.

By mailing address provided above

By my e-mail address

Attach signed and dated authorization form

This file must be in PDF format.