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Medical Records Request

Patients & Visitors

Patient & Visitor Resources

Requesting Mercy Medical Records

The release of personal medical health records can be obtained by completing the appropriate form(s) below and submitting to your Mercy physician's office or local Mercy Health Information Management office.  

  • Patient Request: Access to Protected Health Information (PHI): English | en Español
  • Third-Party Request: Authorization for Use and Disclosure of Protected Health Information: English | en Español

Additional Patient Forms

  • Request for Accounting Disclosures of Protected Health Information: English
  • Request for Amendment of PHI: English
  • Request for Confidential Communication of PHI: English
  • Request for Release Restriction to Insurance Carrier: English

For questions regarding the above forms, please contact your local Health Information Management office:

Health Information Management
430 N. Monte Vista
Ada, OK  74820
580-421-1595

Health Information Management
1011 14th Avenue NW
Ardmore, OK 73401
580-220-6622

Health Information Management
3125 Dr. Russell Smith Way
Carthage, MO 64836
Phone: 417-359-1850
Fax: 417-237-7221
Email: JLNReleaseofInfo_HIM@Mercy.Net

Health Information Management
7301 Rogers Avenue
Fort Smith, Arkansas 72903
479-314-6262

Health Information Management
3462 Hospital Road
Healdton, OK 73438
580-229-1021

Health Information Management
1400 US Highway 61
Festus, MO 63028
636-933-1521

Health Information Management
100 Mercy Way
Joplin, MO 64804
Phone: 417-556-2175
Fax: (417) 556-6576
Email: JLNReleaseofInfo_HIM@Mercy.Net

Health Information Management
1000 Kingfisher Hospital Drive
Kingfisher, OK 73750
405-375-7813

Health Information Management
100 Hospital Drive
Lebanon, MO 65536
417-533-6054

Health Information Management
1000 E. Cherry Street
Troy, MO 63379
636-528-3262

Health Information Management
200 S. Academy Road
Guthrie, OK 73044
405-260-4192

Health Information Management
2710 S. Rife Medical Lane
Rogers, AR 72758
479-338-2962

Health Information Management
4300 West Memorial Road
Oklahoma City, OK 73120
405-752-3614

Health Information Management
1235 E. Cherokee
Springfield, MO 65804
417-820-3200

Health Information Management
10010 Kennerly Road
St. Louis, MO 63128
314-525-1239 (select option 2)

Health Information Management
615 S. New Ballas Road
St. Louis, MO 63141
314-251-4622

Health Information Management
1000 S. Byrd St.
Tishomingo, OK 73460 
580-371-2327

Health Information Management
901 E. Fifth Street
Washington, MO 63090
636-239-8222