Request Medical Records
To request medical records, please print and fill out the applicable form below.
Request for Access to Protected Health Information: Please complete this form to have a copy of your medical records sent to you or to someone other than yourself. Note: Parents and guardians, please use this form for your patients.
Authorization for Release of Information: Third parties, please complete this form to request a copy of an individual’s medical records. Note: The individual whose records are being requested must sign this authorization.
Once completed, mail the forms to:
Health Information Management
ATTN: Release of Information
11133 Dunn Road
St. Louis, Missouri 63136 USA
Please note that a fee may apply.
Christian Hospital and Northwest HealthCare, members of BJC HealthCare, provide world-class medical care to the communities of North County, Greater St. Louis County and Southern Illinois.