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Medical Records

During the COVID-19 issues, the Annex will remain open the regular business hours (Mon – Fri) 8 am – 4:30 pm. We do require anyone entering the building to wear a mask and only one patient within our lobby at a time. If you are not comfortable with coming into our office, you can either download the release form below or call us at 812-825-0905 and we will mail you the release form with instructions.

Patients request a copy of their records for many reasons. Whether you need it for personal reference, or to transfer care to a physician’s office, we are here to help. Patients requesting their own records must sign a release form, and provide a photo identification either in person or by fax. A physician’s office requesting medical records must fax the request to the number listed below on their office letterhead with the patient’s name, date of birth and what information they are requesting.

Charge Policy: The following charges are applicable at each request based on Indiana 760 IAC 1-71-3. Payments may be collected prior to copying and releasing records.

  • A labor fee of $10.00
  • $1.00 per page for the first 10 pages
  • $0.50 per page for pages 11-50
  • $0.25 per page for pages 51 and higher
  • Actual cost of mailing the records
  • Additional $10.00 if the request is for copies to be provided within two working days
  • $20.00 for certifying a patient’s medical records

Treatment, Payments, and/or Operational requests are excluded from copying fees.

  • The charges may apply, but are not limited to the following requests:
  • Patient requesting their own records
  • Attorney requests
  • Disability requests