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How to Request Medical Records

Formerly known as Medical Records, the Health Information Management Department (HIM) maintains patient medical records.

To get a copy of your ELCH medical record, you must sign an authorization form from the HIM Department. Only the patient can release his/her records.

However, if you have the power of attorney or are the executor of a patient’s estate, you may submit a request in writing along with a copy of the legal document stating your role.

How to Request Medical Records

You may also write a letter authorizing East Liverpool Health System to release a copy of your records. In the letter, you must state the patient’s name, date of birth, social security number and date(s) of service. You must sign and date the letter and specify the information to be disclosed. The letter should also state the name(s) of the person (s) to whom the information may be released by the HIM Department. The letter must be signed by the patient on whom the medical record is maintained, or by a person lawfully authorized to act on the patient’s behalf. The letter of request must be dated.

Please allow one week for the records to be copied. There is a retrieval fee and a copying charge. Should you have any questions, please contact us at 330-386-2081.

Hours: 7am-4pm M-F