Requesting Your Medical Records
Access Your Medical Records through MyChart
You can sign up to view your or your child's medical record from your computer or smartphone using MyChart. MyChart enables you to view test results, schedule appointments, or refill prescriptions; however, there are some limitations to what can be viewed in MyChart.
Request Your Medical Records
In the event that you need a complete copy of your SSM Health medical records, you'll need to complete and return the Authorization for Release of Protected Patient Health Information form to your local entity's Health Information Management (HIM) Department.
To request your medical records from a medical group location - including medical group offices located on hospital campuses, use the region specific links below. In processing this request, you will be asked to validate your identity and give authorization for your record's release.
To help us serve you better, please set your location for information on how to access your medical records.
Medical Records Contact Information
In Illinois, complete and return the Authorization for Release of Protected Patient Health Information form.
Mail to:
ATTN: HIM Department
1 Good Samaritan Way
Mt. Vernon, IL 62864
Fax to: 618-899-4764
Questions?
Call: 618-899-2030 Select Option 1
Mail to:
ATTN: HIM Department
400 N. Pleasant Ave.
Centralia, IL 62801
Fax to: 618-436-8016
Questions?
Call: 618-436-8788
Medical Records Contact Information
In Mid-Missouri, complete and return the Authorization for Release of Protected Patient Health Information form.
Mail to:
SSM Health St. Mary's Hospital - Jefferson City
2505 Mission Drive
Attn: Release of Information/HIM
Jefferson City MO 65109
Fax to: 573-681-3632, option 1
Questions?
Call: 573-681-3290, option 1
Monday-Friday, 8 am - 5 pm CST
Medical Records Contact Information
If you are requesting medical records from an Oklahoma hospital, use this Authorization for Release of Protected Patient Health Information form.
Mail or deliver to:
SSM Health St. Anthony Hospital - Oklahoma City
ATTN: Medical Records
1000 N. Lee Ave.
Oklahoma City, OK 73102
Fax to: 405-231-8897
Email to: ssmok.roi@ssmhealth.com
Questions?
Call: 405-272-7400
Your medical records will be available for you to pick up seven to 14 days after we receive your request. We are located on the second floor.
Mail or deliver to:
SSM Health St. Anthony Hospital - Oklahoma City
ATTN: Medical Records
1000 N. Lee Ave.
Oklahoma City, OK 73102
Fax to: 405-231-8897
Email to: ssmok.roi@ssmhealth.com
Questions?
Call: 405-272-7400
Your medical records will be available for you to pick up seven to 14 days after we receive your request. We are located on the second floor.
Mail or deliver to:
SSM Health St. Anthony Hospital - Oklahoma City
ATTN: Medical Records
1000 N. Lee Ave.
Oklahoma City, OK 73102
Fax to: 405-231-8897
Email to: ssmok.roi@ssmhealth.com
Questions?
Call: 405-272-7400
Your medical records will be available for you to pick up seven to 14 days after we receive your request. We are located on the second floor.
Fax to: 405-610-1354
Questions?
Call: 405-610-8084 (Monday-Friday, 8 AM – 4:30 PM)
Mail or deliver to:
SSM Health St. Anthony Hospital - Shawnee
ATTN: Medical Records
1102 W. Macarthur St.
Shawnee, OK 74804
Fax to: 405-878-8162
Email to: ssmok.roi@ssmhealth.com
Questions?
Call: 405-878-8160
Your medical records will be available for you to pick up seven to 14 days after we receive your request. We are located on the second floor.
Mail or deliver to:
SSM Health St. Anthony Hospital - Oklahoma City
ATTN: Medical Records
1000 N. Lee Ave.
Oklahoma City, OK 73102
Fax to: 405-231-8897
Email to: ssmok.roi@ssmhealth.com
Questions?
Call: 405-272-7400
Your medical records will be available for you to pick up seven to 14 days after we receive your request. We are located on the second floor.
Medical Records Contact Information
If you are requesting medical records from a facility in the St. Louis metro area, please use the Authorization for Use and disclosure of Protected Health Information form found under each facility.
If you are requesting medical records from a medical group location - including medical group offices located on hospital campuses - in the St. Louis metro area, please follow the directions found under the Medical Group tab.
Download and complete the Authorization for Release of Protected Patient Health Information form.
Mail to:
SLUCare Physician Group
Attn: Health Information Management
1225 South Grand Blvd.
St. Louis Mo 63104
Fax to:
314-617-2858
Questions?
Call 314-617-2869
Missouri & Illinois Office Locations
If you are requesting your medical records from your primary care or specialty physician office located in the Greater St. Louis area (Missouri) or in the Metro East (Illinois), use this form to complete your request. In processing this request, you will be asked to validate your identity and give authorization for your record’s release.
Other Inquires/Third Party Requests
If you are requesting medical records as a third party or prefer to speak to someone over the phone, please call 866-394-4924 for more information and to make your request.
Download and complete the Authorization for Release of Protected Patient Health Information form.
Mail to:
Health Information Management
1465 S. Grand Blvd.
St. Louis, MO 63104-1095
Fax to: 314-268-6473
Questions? Call: 314-577-5600, ext. 1419 or toll-free 800-366-6119, ext. 1419
Download and complete the Authorization for Release of Protected Patient Health Information form.
Mail to:
SSM Health DePaul Hospital
Attn: Health Information Management
12303 DePaul Drive
St. Louis, MO 63044
Fax to: 314-344-6598
Questions?
Call: 314-344-6295
Download and complete the Authorization for Release of Protected Patient Health Information form.
Mail to:
SSM Health St. Clare Hospital - Fenton
Attn: Health Information Management
1015 Bowles Ave.
Fenton, MO 63026
Fax to: 636-496-4906
Questions?
Call: 636-496-2570
Download and complete the Authorization for Release of Protected Patient Health Information form.
Mail to:
SSM Health St. Joseph Hospital - Lake Saint Louis
Attn: Health Information Management
100 Medical Plaza
Lake Saint Louis, MO 63367
Fax to: 636-625-5419
Questions?
Call: 636-625-5325
Download and complete the Authorization for Release of Protected Patient Health Information form.
Mail to:
SSM Health St. Joseph Hospital - St. Charles
Attn: Health Information Management
300 First Capitol Drive
St. Charles, MO 63301
Fax to: 636-947-5258
Questions?
Call: 636-947-5362
Download and complete the Authorization for Release of Protected Patient Health Information form.
Mail to:
SSM Health St. Joseph Hospital - St. Charles
Attn: Health Information Management
300 First Capitol Drive
St. Charles, MO 63301
Fax to: 636-947-5258
Questions?
Call: 636-947-5362
Download and complete the Authorization for Release of Protected Patient Health Information form.
Mail to:
SSM Health Saint Louis University Hospital
Attn: Health Information Management
1201 S. Grand Blvd.
Saint Louis, MO 63104
Fax to: 314-257-7161
Questions?
Call: 314-257-7160
Download and complete the Authorization for Release of Protected Patient Health Information form.
Mail to:
SSM Health St. Mary's Hospital
Attn: Health Information Management
6420 Clayton Road
Richmond Heights, MO 63117
Fax to: 314-768-8853
Questions?
Call: 314-768-8133
Medical Records Contact Information
If you are requesting medical records from a facility in Wisconsin, please use the Authorization for Use and disclosure of Protected Health Information form found under each facility.
For more information on how to request your medical records from SSM Health Fond du Lac Regional Clinic, SSM Health Ripon Community Hospital, SSM Health St. Agnes Hospital - Fond du Lac or SSM Health Waupun Memorial Hospital, please call 920-926-8328.
Download and complete the Authorization for Release of Protected Patient Health Information form.
Complete the form you need with the required information. Be as specific as possible.
Patient Authorization Protected Health Information: Use this form to request copies or transfers of your medical records. English | Spanish
Patient Revocation of Authorization to Disclose Protected Health Information: Use this form to revoke (cancel) a previous medical records authorization. English
Patient Request to Amend Health Information: Use this form to request an amendment to existing health information. English
Patient Authorization to Release Pharmacy Records: Use this form to request copies of your SSM Health Pharmacy records. English
Permission for Verbal Communication: Use this form to allow communication to other persons involved in your medical care. English | Spanish
Release Restriction Form: Use this form to request restrictions on release of protected health information. English
Accounting of Disclosure Form: Use this form to request an accounting of releases of PHI, pursuant to patient authorization and as otherwise regulated to state law. English
Deliver by Hand:
Give your completed form to your Medical Group's Patient Services department.
Mail it:
SSM Health Dean Medical Group Health Information
Attn: Release
P.O. Box 259840
Madison, WI 53725-9840
Fax it:
Attn: Release
608-294-6294 or 877-469-7593
Email it:
Email your completed form to HealthInformation@ssmhealth.com
Questions?
Call: 608-294-6244 or 877-510-1873
Fees:
Please call for current copy fees. You can expect your request to take 10-30 business days to be processed. This timeframe is dependent on the number of records being copied and transferred.
Request Your Medical Records
Complete the form you need with the required information to request your medical records.
- Authorization for Use and Disclosure of Protected Health Information (English)
- Authorization for Use and Disclosure of Protected Health Information (Spanish)
Mail it:
SSM Health Monroe Hospital, Health Information Management
515 22nd Ave
Monroe, WI 53566
Email it:
MON-release.of.info@ssmhealth.com
Fax it:
608-324-1148
If you have questions please call one of our representatives at 608-324-2270.
Permission for Verbal Communication
Use this form to allow communication to other persons involved in your medical care.
Mail it:
SSM Health Monroe Hospital, Health Information Management
515 22nd Avenue
Monroe, WI 53566
Email it:
MON-HIM@ssmhealth.com
Fax it:
608-324-2134
If you need to withdraw your authorization for verbal authorization or have any questions regarding authorizing verbal communication, contact us at 608-324-2235.
Amend or Correct Protected Health Information
Download the Authorization for Use and disclosure of Protected Health Information form.
Mail to:
SSM Health Hospitals
PO Box 259840
Madison WI 53725-9840
Phone: 608-270-6806
Fax: 608-270-6815
Fees:
Please call for current copy fees. You can expect your request to take 10-14 business days to be processed.
Download the Authorization for Use and disclosure of Protected Health Information form.
Mail to:
SSM Health Hospitals
PO Box 259840
Madison WI 53725-9840
Phone: 608-270-6806
Fax: 608-270-6815
Fees:
Please call for current copy fees. You can expect your request to take 10-14 business days to be processed.
Download the Authorization for Use and disclosure of Protected Health Information form.
Mail to:
SSM Health Hospitals
PO Box 259840
Madison WI 53725-9840
Phone: 608-270-6806
Fax: 608-270-6815
Fees:
Please call for current copy fees. You can expect your request to take 10-14 business days to be processed.
Include Proof of Identification
SSM Health takes patient privacy very seriously. Therefore, a copy of the patient’s legal guardian's ID is required to request medical records. We need this identification to verify that you are authorized to request the patient’s records. This can be a state-issued ID, birth certificate, etc. If you have any questions about what type of ID is accepted, please contact HIM. Birth certificates must be acquired from your state’s Department of Health & Family Services.
To help us serve you better, please set your location for information on how to access your medical records.
Receiving Your Records
After the authorization form is filled out and received by our office we will provide a copy of your medical records. You can receive your records in a variety of ways including:
- By mail via the U.S. Postal Service
- By picking them up in person after making arrangements with Health Information Management (HIM).
In addition, your entity may offer other options for receipt of your medical records.
We do our best to expedite all requests, but in some instances it can take up to 30 business days to complete the request.
Receiving Your Records
After the authorization form is filled out and received by our office we will provide a copy of your medical records. You can receive your records in a variety of ways including:
- By mail via the U.S. Postal Service
In addition, your entity may offer other options for receipt of your medical records.
We do our best to expedite all requests, but in some instances it can take up to 30 business days to complete the request.