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Health Information Management 
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| Phone Number: (740) 393-9051
Fax Number: (740) 399-3113
Office Hours: 8:00am to 4:30pm, Monday – Friday
Closed Weekends and Holidays |
 The Health Information Management team at Knox Community Hospital is a group of specially trained medical information specialists who generate and compile accurate and timely medical information about Knox Community Hospital patients.
The confidentiality of your medical information is of great importance to us, and we take special care to respect that confidentiality. We abide by a strict policy that any information of a medical nature in our possession must not be revealed by any staff member of the hospital except under specific guidelines.
For your protection, these guidelines include specific requirements for obtaining your own medical records. Please review the requirements to help us honor your request quickly and efficiently. If you have questions, please contact Health Information Management at (740) 393-9051.
What is a medical record?
Your Knox Community Hospital medical record is a summary of your medical history and the treatment provided to you at our hospital. It may include any or all of the following:
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Your History and Physical (H&P)
Test Results
Consultations
Nursing Documentation
Physician Documentation
Discharge Summary |
How do I obtain a copy of my medical record?
For your protection, we require that you, your guardian or legal representative, submit a request for the record in person, in writing and complete an authorization form (click here to download MR-43 Patient Request for Medical Records). Please give your name, Social Security Number, and birthdate. The written request must indicate where to send the records and be signed and dated by the authorized requestor. It would also be helpful to give the date of service at Knox Community Hospital you are requesting. Submit written requests to:
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Health Information Management
Knox Community Hospital
1330 Coshocton Road
Mount Vernon, OH 43050 |
You may pick up your record in the Health Information Management office, located on the first floor of the main hospital building. Our hours are 8:00am – 4:30pm, Monday through Friday. Please bring a valid photo identification with you.
To pick up the medical record you will need to:
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Show your photo identification
Provide signature verification
Pay any charges |
Can someone else pick up my medical record for me?
Not without the proper authorization from the patient, guardian, or legal representative. Click here to download AD-66 Authorization for Uses and Disclosures of Patient Information.
Can you mail copies the medical record?
Yes, but for your protection, authentication is still required. If you need to have us mail your record, please call us at (740) 393-9051 and we will make the necessary arrangements.
Is there a charge for obtaining copies of my medical record?
The following charges may be assessed:
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Pages 1–10: |
$2.50 |
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Pages 11–50 |
$ .51 |
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Pages 51+ |
$ .20 |
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Plus any applied postage |
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What if the patient is under 18?
The parent or legal guardian must request and pick up the record.
What if the patient is deceased?
The spouse or the executor of the estate may request and obtain the record with proper legal documentation.
What if someone besides myself needs a copy of my medical record?
Your medical information is private and confidential. In compliance with the federal government Health Insurance Portability and Accountability Act, Knox Community Hospital will not release records without proper authorization from you, your guardian or legal representative. Click here to download AD-66 Authorization for Uses and Disclosures of Patient Information.
I've changed physicians. Can I get copies of my hospital records sent to a different healthcare provider?
Yes. There is no charge for this service. You, your guardian or legal representative will need to mail or fax a written request or complete an AD-66 Authorization for Uses and Disclosure of Protected Health Information form and submit it to Health Information Management to be processed. There is no charge to have medical record copies sent directly to a healthcare provider for your continued health care. |
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