Request Medical Records

CHI Mercy Health is required by law to maintain the privacy of your health information, to provide you with a notice of our legal duties and privacy practices, and to follow the information practices that are described in our Notice of Privacy Practices.

You have the right to receive a copy of your health information that we maintain, with some limited exceptions. You have the right to receive a copy of your health information in a format you prefer (e.g., paper, email, CD). You have the right to request that your health information to be sent to any person or entity.

CHI Mercy Health gives you, or your authorized representatives, two options for accessing your CHI Mercy Health medical records:

• View your information via PtAccess, the patient portal.  Mercy’s Patient Portal gives you online secure access to your information and pay medical bills online.
  Patient Portal

• Request a copy of your medical records.
• Fillable Proxy Consent Forms available:

Adult Proxy Consent Form

Adolescent Proxy Consent and Directed Access Request Form

Child Proxy Request Form

Revocation of Access Consent Form

Starting the process for a request for Medical Records

1. Complete and sign this form.
   • For Imaging specific requests, please fill out this Release of Information form and email it to [email protected]. To pick up the image records in person if you are not the patient, a letter from the patient is required, giving permission for the pickup and photo identification. Please email us for details on what the letter must include.
2. Please DO NOT EMAIL THIS FORM.  It contains your personal information and most email is not secure.  You can:
   • Bring the form to Mercy Medical Records Office
   • Fax the completed and signed form to 541.677.2459
   • Utilize your patient portal account to securely submit your signed and scanned form.

Electronic Request for Records

CHI Mercy Health now offers an online patient request that verifies your identity by asking for a photo of your driver’s license, which can be taken via webcam or smartphone. Please note: Chrome, Safari and Firefox are the browsers for this application.

Request Records Electronically

Cost

For medical use, there is no fee if records are to be sent directly to a doctor or other healthcare provider for the purpose of continuing care.

For copies for patients or their representatives, there will be a reasonable, cost-based fee.

For copies or other uses, the current rates set by Oregon state law may apply as follows for Hospital Medical Records. Datavant is the approved release of information vendor for Mercy Medical Center.

• All invoices are sent from Datavant along with the records. Datavant does not prepay patients. If records are picked up, an invoice will be mailed.

• Electronically maintained medical records delivered in electronic format $6.50.

• Electronically maintained medical records combined with paper records delivered in electronic format are billed at $6.50 (for the electronic portion) + $0.07 per page (for the paper portion) for labor involved in creating an electronic copy of the records maintained on paper.

• Electronically maintained medical records delivered on paper are $0.90 for labor cost to create the paper copy of the record maintained electronically plus $0.05 per page for paper and toner.

• Paper records delivered in electronic format are $0.07 per page for the labor involved in creating an electronic copy of the records.

• Paper records delivered on paper are $0.12 per page.

• Plus, postage and applicable taxes

Processing your request

We will make records available in a timely fashion not to exceed 15 working days. If we’re not able to make records available at the time of request, we will inform you of the status of your medical records and produce your medical record within 21 days from the receipt of the request. If the information requested does not exist or cannot be found you will be notified within 15 working days. Medical records usually are mailed. If records are picked up, a valid photo ID must be presented.

If someone other than the patient picks up records, this must be specified on the Authorization for Disclosure form. The person picking up must show a valid photo ID.

Getting copies of radiology images

You can request copies of your imaging films (X-rays, MRI scans, CT scans, mammograms) by contacting the CHI Mercy Radiology or Imaging Center where you had service.