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 are:
Our fax numbers are:
Our mailing address is:
Your request will be processed and fulfilled within ten working days after receipt.
(In all cases, please call the Release of Information Desk to discuss your questions in greater detail.)
Q-Is there a charge for copies?
A - At times there will be a charge for copying and releasing your medical records.
Q-May my spouse request copies of my medical records?
A - Only the patient may authorize the Medical Center to release copies of their medical records.
Q-May my spouse receive copies of my medical records?
A - Only if you authorize the Medical Center to release the copies of your medical record to them.
Q-May I request and receive copies of the medical records of my child?
A - 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.
Q-May I request and receive copies of the medical records of my step child?
A - Only the biological parents may authorize the Medical Center to release copies of their minor child's medical records.
Q-May I request and receive copies of the medical records of my deceased family?
A - Please call the Release of Information Desk to discuss in greater detail.
Q-Will you mail the copies or will I have to pick them up?
A - 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 7 a.m. to 5 p.m., Monday through Friday. All other times need to be pre-arranged with the department.
Q-Will you fax the copies to my home or office?
A - Due to confidentiality issues, we cannot fax medical records to your home or office.
Q- May I obtain a copy of medical records on a CD from you?
A - 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 received the records on a CD.
Q-May I obtain a copy of my x-ray films or CDs from you?
A - 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.
Q-How do I request a copy of my birth certificate?
A - Coffeyville Regional Medical Center does not keep birth certificates. You may request a copy from the state Vital Statistics department via the following link: