MUST wear a face mask to enter the Annex building to keep you and our staff safe.
Only 1 person requesting records may enter and
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, and provide a photo identification either in person or by fax. A physician’s
office requesting medical records must fax the request to the number listed
below on their office letterhead with the patient’s name, date of
birth and what information they are requesting.
Charge Policy: The following charges are applicable at each request based
on Indiana 760 IAC 1-71-3. Payments may 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
- $20.00 for certifying a patient’s medical records
Treatment, Payments, and/or Operational requests are excluded from copying fees.
- The charges may 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