Request release of your medical record information to a third party >
Request access to your own medical record >
Print these forms, complete them and mail them to:
Health Information Management
ATTN: Release of Information
11133 Dunn Road
St. Louis, Missouri 63136 USA
(These forms are in PDF format and require Adobe Acrobat Reader. If you don't have this software, go to Adobe for a free download.)
If you have questions, call 314.653.5116 or 314.653.5113 between 8 a.m.– 4:30 p.m., Monday through Friday.
Please note that a fee may apply.