Susan Stanley, RHIT
Director of Health
Information Management
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PATIENT MEDICAL RECORDS

  • Patient's full name and date of birth (list any other names the patient may have had)

  • Telephone number

  • Medical Record Number (if available)

  • Specific information being requested (e.g., type of report/information and dates of service, etc.)

  • Purpose for which the information is being disclosed

  • To whom the information is to be sent (name, address, and phone)

  • Authorizations are good for one year from signature date unless otherwise specified

  • The patient's signature or a patient's legal representative's signature. Authorizations signed by a representative must contain a copy of the guardianship papers or power of attorney

  • Date of the signature

 

To request your medical records, you may complete and mail the Request to Inspect or Copy Health Informationor send a written request complete with the following information:

All written requests should be mailed to:

Clara Barton Hospital

Health Information Management (HIM)
250 West 9th Street
Hoisington, KS 67544


Phone: (620) 653-5092
Fax: (620) 653-2671

Email: HIM@cbhks.com

 

Your request will be processed within 30 days, and will be sent to you, or

you may pick up your medical records in our office between 8:00am and 4:00pm.

 

Processing Fee: We will notify you by phone in advance if there will be a charge for your records.

For Life-Threatening Emergencies Call 911