To obtain a copy of your medical records from a University Hospitals inpatient facility or outpatient facility, please contact the facility. For physicain office records, please contact the office.

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FORM
Authorization for Release of Medical Information (PDF format)

UH Bedford Medical Center - (440) 735-3569
44 Blaine Avenue
Bedford, OH 44146
website: www.uhbedford.org

UH Case Medical Center - (216) 844-3555
11100 Euclid Avenue
Cleveland, OH 44106
website: www.uhhospitals.org/case

UH Conneaut Medical Center - (440) 593-0253
(formerly Brown Memorial Hospital)
158 West Main Road
Conneaut, OH 44030

UH Extended Care Campus - (440) 279-2497
12340 Bass Lake Road
Chardon, OH 44024

UH Geauga Medical Center - (440) 285-6373
(formerly Geauga Regional Hospital)
13207 Ravenna Road
Chardon, OH 44024
website: www.uhgeauga.org

UH Geneva Medical Center - (440) 415-0203
(formerly Memorial Hospital of Geneva)
807 W. Main Street
Geneva, OH 44041
website: www.uhgeneva.org

UH Richmond Medical Center - (440) 585-6413
(formerly Richmond Heights Hospital)
27100 Chardon Road
Richmond Hts., OH 44143-9985
website: www.uhrichmond.org

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FEES

Medical records are provided as a courtesy for continuity of clinical care.

The State of Ohio provides a two-tiered fee schedule for the cost of providing copies, one for patients and another for others.

One free copy of a patient's medical record is provided, on receipt of appropriate request, to:

• The Bureau of Workers' Compensation, the Industrial Commission, or the Ohio Department of Job and Family Services;
• Patient or patient's representative if the record is necessary to support a claim for Social Security disability benefits and the request is accompanied by documentation that the claim has been filed.

The fee schedule for a patient or a patient's personal representative is as follows:

• No records search fee
• For data recorded on paper:
• $2.84 per page for the first 10 pages
• $0.59 per page for pages 11 through 50
• $0.24 per page for pages 51 and higher
• For data recorded other than on paper (i.e. x-rays):
• $1.94 per page
• Actual cost of postage

The fee schedule for all other requestors is as follows:

• $17.48 records search fee
• For data recorded on paper:
• $1.15 per page for the first 10 pages
• $0.59 per page for pages 11 through 50
• $0.24 per page for pages 51 and higher
• For data recorded other than on paper (i.e. x-rays):
• $1.94 per page
• Actual cost of postage