Medical Records

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Information

Two locations:

Memorial Hospital Central
Health Information Management (Medical Records), Room 2402
1400 E Boulder St Colorado Springs CO 80909
1400 E. Boulder St.
Colorado Springs, CO 80909
(map & directions)

Business Hours:
9:00 a.m. to 4:00 p.m.

Telephone:
(719) 365-5277

Fax:
(719) 365-6974


Memorial Hospital North
Medical Records, Room AG105
(Located in the basement adjacent to the cafe)
4050 Briargate Pkwy.
Colorado Springs, CO 80920
(map & directions)

Business Hours:
9:00 a.m. to 4:00 p.m.

Telephone:
(719) 364-2351

Fax:
(719) 364-3540


Mission
Store, protect, and deliver accurate medical information to authorized users to support Memorial Hospital.

In Person Medical Record Requests: Bring a valid state-issued identification card and complete a request at any location to the left. Online Requests: In State ONLY; and must be picked up by the patient with valid state-issued identification card. Out of State Requests: Print, Complete, sign, and return request by mail with a copy of your valid state-issued identification card. All payments for medical record requests must be received prior to release of medical records. Please allow up to ten (10) business days to process your request. Please contact the Health Information Management (HIM) department at any one of the locations to the left if you have additional questions or concerns. 719-365-5277


Reviewing a Medical Record
You have the right to review a copy of your records or the records of your minor children when lawfully permitted. You must have a valid state-issued identification card to review any medical records. Please call ten (10) business days in advance to ensure the records are available for your review.


Obtaining a Copy of a Medical Record
You may request a copy of your medical records, however, Memorial Hospital is required by law to obtain your written permission before disclosing any medical information. In-person requests: Bring a valid state-issued identification card and complete a request at any location to the left. Online Requests: In State ONLY; and must be picked up by the patient with valid state-issued identification card. Out of State Requests: Print, Complete, sign, and return request by mail with a copy of your valid state-issued identification card. Charges are listed below, if applicable.


No charge for pages 1-10
.50 cents for each page from 11-40
.33 cents for each additional page




Authorization to Disclose Health Information - Electronic Form


Authorization to Disclose Health Information - English (.pdf)


Authorization to Disclose Health Information - Spanish (.pdf)


Directions for completing the Authorization Forms (.pdf)


If you are requesting records for a patient that is over the age of 18, a Medical Durable Power of Attorney will be required prior to their release.

If the patient is deceased, a death certificate is required and the records can only be released to the informant named on the death certificate.

 
Receiving Your Requested Records
It may take up to 10 business days to process your request. Please bring a valid state-issued photo id.
 
Payment for Records
Memorial Hospital is authorized by Colorado State Law 6 CCR 1011-1, paragraph 5.2.3.3 to charge fees for providing copies of medical records. The fee is contingent upon the reason for your request. We will only accept cash, major credit cards, and debit cards as payment. No personal checks will be accepted. The fees are as follows:

No charge for pages 1-10
.50 cents for each page from 11-40
.33 cents for each additional page
 
Advice When Requesting Copies of Medical Records
Requests for “entire medical records” can delay processing, become very costly and can sometimes be much more information than you really need. Contact the HIM department if you need help deciding what to request. 719-365-5277
 
Requesting an Amendment to a Medical Record
You may complete a Request for Amendment if you believe something needs to be revised or corrected. Please be aware Memorial Hospital is NOT required to amend your medical records for the following reasons (1) we did not create the information, (2) we do not maintain the information as part of your record, (3) we determine the information is accurate and complete as currently recorded, or (4) the information is the type that would not be available to you for inspection.

Request for Amendment to Medical Records (.pdf)