Release of Medical Record Information

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 click the purple "Sign Up Now" button.

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 Health icon in the menu at the top of the screen.
2. Select "Record Requests".

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.

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.

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

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

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 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.