Home > Contact > Medical Records

Medical Records

Patients request a copy of their records for many reasons.  Whether you need it for personal reference, or to transfer care to a physician’s office, we are here to help.  Patients requesting their own records must sign a release form, either in person or by fax (see fee schedule below).  A physician’s office requesting medical records must fax the request to the number listed below on their office letterhead.

Charge Policy:  The following charges are applicable at each request based on Indiana 760 IAC 1-71-3.  Payments shall be collected prior to copying and releasing records.

  • A labor fee of $10.00
  • $1.00 per page for the first 10 pages
  • $0.50 per page for pages 11-50
  • $0.25 per page for pages 51 and higher
  • Actual cost of mailing the records
  • Additional $10.00 if the request is for copies to be provided within two working days
  • $20.00 for certifying a patient’s medical records

Treatment*, Payments, and/or Operational requests are excluded from copying fees.

  • The charges shall apply, but are not limited to, the following requests:
  • Patient requesting their own records
  • Attorney requests
  • Disability requests

Phone:  (812) 825-0905
Fax:  (812) 825-0784

Download the Release of Information Form

Download the Notice of Privacy Practices