To obtain a copy of your medical records from University Hospitals Case Medical Center, simply download, complete, sign and date the Authorization for Release of Medical Information  and fax or mail it back to us. Unsigned requests cannot be processed.

Our fax number is (216) 844-7493

Our mailing address is:
Health Information Services
University Hospitals
11100 Euclid Ave.
Cleveland, OH 44106-5023

Your request will generally be processed and fulfilled within ten working days. We will either mail your copy to the address specified on the authorization form, or you may pick up your copy from our offices located at the address above, between the hours of 8:00 am and 4:30 pm, Monday through Friday.

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FORM
Authorization for Release of Medical Information (PDF format)

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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