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Release of Medical Record Information

At this time, our Health Information Management Release of Information area is closed to patients, guests and visitors. We are still available to assist with your medical record needs in other ways. If you would like to request copies of your records, you may do any of the following:

Indianapolis / Howard / Anderson

  • Make a request via MyChart
  • Call our Release of Information line at 317-355-5802
  • Email your request to ROIRequests@eCommunity.com
  • Fax a signed and dated request to 317-351-7728
  • Mail a written request to Community Health Network, Attn: HIM, 1500 North Ritter Avenue, Indianapolis, IN 46219

Community Health Network patients may request free copies of their medical records via mail, fax or MyChart. See instructions below for patients, healthcare providers and third parties. *Behavioral health and Community Rehab Hospital patients, please note specific instructions.

Chart corrections may be requested in MyChart or by completing this Request for Amendment form and emailing patientamendments@eCommunity.com.

Need help? If you have questions about the process for requesting medical records, please contact the HIM Release of Information department directly at 317-355-5802.

Patient Requestors - General

There are multiple ways to request a copy of your medical record, including online through MyChart or by mail.

MyChart

Community Health Network patients can now request copies of their medical records using the electronic request form within their Community MyChart account.

If you do not yet have a MyChart account, you can easily create one. Visit the MyChart website and go to Create an Account on the right-hand side. Choose if you have an activation code or need an activation code and follow the steps to create an account.

Records will be delivered electronically back to your MyChart account. Our goal for delivery is within 3 business days, but due to volume of requests received, it may take up to 14 business days.

Log Into MyChart

  1. Once logged into MyChart, click the "Your Menu" icon at the top left.
  2. Scroll down to the "My Record" section.
  3. Select "Record Request" to fill out your request.

Mail or Fax

  1. Download and complete this form: Patient Access Request for Medical Records (PDF).
  2. Mail or fax the form to our centralized HIM location:

Community Health Network
Attn: HIM Release of Information
1500 North Ritter Avenue.
Indianapolis, IN 46219
Fax: 317-351-7728

Please allow 7-14 business days for completion of a medical records request. Please note that it can take up to 30 days as allowed by law.

Behavioral Health Patients

You may request a copy of your behavioral health record for yourself or to release it to other parties.

  1. To receive a copy of your behavioral health record, download and complete this form: Patient Access Request for Medical Records (PDF).
  2. To release your behavioral health record to anyone other than yourself, download and complete this form: Authorization to Release and Disclose Patient Information (PDF).
  3. Mail or fax the form to our centralized HIM location:

Community Hospital East
Attn: HIM Release of Information
1500 North Ritter Avenue
Indianapolis, IN 46219
Fax: 317-351-7728

Please Note: For patients requesting copies of their behavioral health records, all treating providers must review and approve the request prior to the release of any information. This review may take an additional 7-10 days to process.

Community Rehabilitation Hospital Patients

To request patient records from Community Rehab Hospital North or South, download and fill out this form: Patient Request for Release of Information (PDF)

Mail or fax the request form to the appropriate location:

Community Rehabilitation Hospital North
Attn: HIM Department
7343 Clearvista Drive
Indianapolis, IN 46256
Fax: 317-585-5472

Phone: 317-585-5423
Hours: Monday - Friday, 8 a.m. to 4 p.m.
Main hospital phone: 317-585-5400

Community Rehabilitation Hospital South
Attn: HIM Department
607 Greenwood Springs Drive
Greenwood, IN 46143
Fax: 317-215-3801

Phone: 317-215-3810
Hours: Monday - Friday, 8 a.m. to 4:30 p.m.
Main hospital phone: 317-215-3800

Fairbanks

Release Records: To request a Fairbanks patient record be shared with another party, download and fill out the Consent for Mutual Disclosure form.
Request Chart Corrections: To request a correction to your Fairbanks medical chart, download and fill out the Request for Record Amendment form.

Return forms to:

Mail to: Fairbanks, Attn: Medical Records, 8102 Clearvista Pkwy, Indianapolis, IN 46256
Fax: 317-849-7354
Phone: 317-849-8222 or (toll-free) 800-225-4673, Option 6
InteliChart PatientPortal: https://patientportal.intelichart.com/login

Healthcare Providers

Fax your authorization or facility's coversheet/letterhead to 317-351-7728. Please include patient's identifiers, contact information and description of information you are seeking.

Fax hours are Monday - Friday, 8 a.m. to 4:30 p.m.

For release requests after hours/weekends/holidays, please call HIM at 317-355-5752.

Other Requestors

Other requestors may include attorneys, insurance, third-party services, etc.

Download: Authorization to Release and Disclose Patient Information (PDF)

1. Mail to:

Community Health Network
Attn: HIM Release of Information
1500 North Ritter Avenue
Indianapolis, IN 46219

2. Fax your request letters with authorization to 317-351-7728.

Please note that it can take up to 30 days as allowed by law.