Protecting your confidential health information is important to us. Our Release of Information Department maintains your medical records, so it remains safe and available to you when you need it.
Your medical record is a summary of the services you received during your hospital visit. It contains your
- Health history
- Lab tests
- Nursing notes
- Physical exams
- Prescribed medications
- Plans for further care
We maintain a confidential medical record for each patient we treat, and, as a patient, you have the right to view that record.
Requesting a Copy
To request a copy of your medical record, complete and submit this authorization form [PDF]. You will also need to include a copy of your photo ID.
To request your medical records to be emailed, complete the form above as well as this email consent form [PDF].
Please allow for ten business days to process your request. Information located off-site or authorization forms that are improperly filled out take longer to process.
If your request requires a fee, you will be notified of the fee before the record is sent.
You can securely access portions of your medical record online through MyChart. To do this, you must activate your Kettering Health MyChart account.
Kettering Health Information Systems will contact you when your access is granted.
Mail complete forms to the following:
Release of Information Department
1 Prestige Place, Suite 540
Miamisburg, OH 45342
Who Can Access My Medical Record?
Your medical record is a confidential legal document and can be requested only by the following:
- You, the patient (not your spouse)
- Your parent if you are younger than 18.
- Your legal guardian (with proof of guardianship document)
- Your power of attorney if you are unable to sign (with legal documentation provided).
Requests for medical records of a deceased person require the following legal documentation:
- Court appointed Executor of Estate, Death Certificate, and a signed consent to request the records.
- Court appointed Affidavit of Kinship, Death Certificate, and signed consent to request the records.
*Please note, after a patient’s death, The Medical Power of Attorney (POA) is ceased and no longer valid.
Cost to Request
There is no cost when the request for your medical record is made by
- Your physician (request by calling the Kettering Health Release of Information Department at (937) 752-2200 or by faxing a request on office letterhead to (937) 522-8444)
- Ohio Department of Job and Family Services
- Social Security disabilities benefits (request must include documentation that verifies the filing of the claim)
There is a prepaid cost when your medical record is requested by
- Insurance companies
- Patients and their families
The cost for a paper copy includes a flat fee of $18.50 plus the cost of postage. An electronic copy requires a flat fee of $6.50.
Obtaining Other Records
Your medical record does not contain birth certificates, death certificates, or imaging films (such as X-rays).
To request a copy of a birth or death certificate, contact the following:
Montgomery County Vital Statistics
To obtain copies of imaging films, please contact the appropriate radiology location.