Medical Records
Requests from Patients
To obtain a copy
of your medical record from St. John's Mercy Medical Group, please
complete our
Request for Access to Health
Information Form and mail or fax the completed form to your SJMMG physician's
office. SJMMG may charge you a reasonable per page copy charge allowed under
Missouri law and a postage charge (if applicable). A handling fee will not
be charged for patients requesting a copy of their record.
Authorization for Use and
Disclosure of Protected Health Information
If you would like
St. John's Mercy Medical Group to release your medical record to a third-party,
please complete our Authorization
for Use and Disclosure of Protected Health Information and mail
or fax the completed form to your SJMMG physician's office.
For medical record requests
from sources other than patients (e.g., attorney’s, insurance companies), SJMMG
may charge $18.49 plus $0.44 per page for the cost of supplies and labor (effective
2/1/07).
If you have questions or
would like additional information regarding your medical record, please contact
your SJMMG physician's office.
