Request Medical Records

Obtaining a copy of your medical record is easy. If you are a currently in the medical center, please request an authorization form from any employee. After completing and signing the form, ask the employee to send the form to Health Information Management (also known as Medical Records) through our inner-office mail system.

If you are using the Internet, simply download, print, complete and sign the authorization form and either fax or mail it back to us at the address listed below.

Please be sure to sign the form. Unsigned requests cannot be processed.

Our phone numbers

  • Release of Information Desk: 620-252-1152
  • Reception Desk: 620-252-1152

Our fax numbers

  • Release of Information Desk: 620-252-1504

Our mailing address

Coffeyville Regional Medical Center
Health Information Management Department
Attention: Release of Information
1400 W. 4th St.
Coffeyville, KS 67337
Your request will be processed and fulfilled within 10 working days after receipt.

Frequently Asked Questions

(In all cases, please call the release of information desk to discuss your questions in greater detail.)

At times, there will be a charge for copying and releasing your medical records.

Only the patient may authorize the Medical Center to release copies of their medical records.

Only if you authorize the Medical Center to release the copies of your medical record to them.

Only if your child is under the age of 18; otherwise, they have to authorize the Medical Center to release copies of their medical records to you.

Only the biological parents may authorize the Medical Center to release copies of their minor child’s medical records.

Please call the Release of Information Desk to discuss in greater detail.

We will either mail your records to the address specified on the form or you may pick up your records from our offices. Please specify how you would like to receive the records on the form. Our office hours are Monday – Friday, 7 a.m. to 5 p.m. All other times need to be pre-arranged with the department.

Due to confidentiality issues, we cannot fax medical records to your home or office.

Yes, the Medical Center will be happy to provide you with a copy of your medical record on a CD. On the form, please specify you would like to receive the records on a CD.

Yes, the Medical Center will be happy to provide you with a copy of the films or CDs. Please note charges may apply to copy the films or CDs.

Coffeyville Regional Medical Center does not keep birth certificates. You may request a copy from the state Vital Statistics department.