Patients & Visitors

Medical Records Release

Patients & Visitors > Medical Records Release

If you would like to request a copy of your medical records, please download the appropriate Toledo Clinic Authorization Form. This form must be completed and signed for The Toledo Clinic to release your medical records to you or another party. Once completed, please return the forms to:
Toledo Clinic Medical Records
4235 Secor Road
Toledo, OH 43623
or fax to 419-214-1979

To contact Medical Records, please call 419-479-5930.

Toledo Clinic medical record release requests are processed by Bactes Imaging Solutions; their customer service phone number is 248-977-3926.

Please allow time for processing and be aware that there may be a financial charge for medical record copies.

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Instructions for completing the Authorization for Use or Disclosure of Medical Record Information
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Authorization for Use or Disclosure of Medical Record Information Standard Form
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Authorization For Use or Disclosure of HIV Testing Information Form
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Authorization For Use or Disclosure of Mental Health or Psychotherapy Notes/Information Record Information Form
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Authorization For Use or Disclosure of Substance Abuse Notes/ Record Information Form

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