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Medical Records Banner

Medical Records Request


Thank you for choosing a Mercy facility to receive your medical care. If you find that you need access to or a copy of your medical records, please print and complete the appropriate form found at the bottom of this page. Mail the completed form to the Mercy facility where you received the service at the address listed.

If you need help to fill-out the release form, or to speak to someone regarding your request, or to set an appointment time to view your records, please use the hospital contact numbers listed below.

Records are kept off site so please allow time for processing. A picture ID is required when picking up medical records. If you select to have your medical records mailed to your home or to another location, a copy of your photo ID must be included with the mailed or faxed request.

Mercy St. Anne
CDMC
947 S. Wheeling
Oregon, OH 43616
Phone:
419-696-5527

Fax:
419-696-5510

Mercy St. Charles   
CDMC
947 S. Wheeling
Oregon, OH 43616   
Phone:
419-696-7399
419-696-2502
Fax:
419-696-7702

Mercy St. Vincent
CDMC
947 S. Wheeling
Oregon, OH 43616
Phone:
419-696-5802
419-696-5572
Fax:
419-696-5570

Mercy Tiffin
Health Information
45 St. Lawrence Dr.
Tiffin, OH 44883
Phone:
419-455-7250

Fax:

419-455-7257
Mercy Willard
Health Information
1100 Neal Zick Rd.
Willard, OH 44890
Phone:
419-964-5050

Fax:
419-964-5061
Mercy Defiance
Health Information
1404 East Second St.
Defiance, OH 43512
Phone:
419-785-3994

Fax:
419-782-0219


Authorization/Request Forms
Mercy maintains adult medical records for 10 years from the date of service. Records for minors (under age 18) are maintained for 20 years.
  To request copies of your personal medical records or the records of someone you have legal representation over, i.e. Minor Child, Guardian, POA, Executor of the Estate, Surviving Spouse, etc. use this form:
Request to Access Form

To have records sent to another party, i.e.physician, attorney, your spouse or another family member, use this form:
Authorization to Disclose

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Copyright ©2013 Mercy. Last modified 8/13/2013