Medical Records Release Forms
How do I get access to my medical records at Cleveland Clinic?
For you, as a patient, there are processes in place to allow you to review, comment upon and make amendments to your medical record. Your bedside nurse or nurse manager of your hospital unit can help you with this upon request.
You may request copies of your patient record. If you would like to ensure the copies of your record reflect the entire episode of care, you may consider requesting your patient record after discharge or at the end of your care episode. Please contact Health Information Management at 216.444.5580 for more information. Hours are 8 a.m. - 5 p.m., Monday - Friday.
To request information from Cleveland Clinic:
- Authorization for the Release of Medical Information
- Authorization for the Release of Medical Information (Spanish)
- Complete all fields on the authorization form(s) when requesting the release of your records.
- If you do not know your Cleveland Clinic number, leave it blank.
- After the form(s) is signed and dated, fax the information to the number indicated at the top of the form or mail it to the address indicated.
Typical processing time to request medical records is seven to 10 business days, depending on the availability of the medical record.
To request radiology images:
For radiology image requests, please allow 48 hours.
To request information from other facilities:
To give Cleveland Clinic access to outside medical records, you will need to authorize release from your current medical provider(s). Please complete the form and send it to your current provider for processing.
MyChart is a secure, online tool that connects you to a portion of your personalized health information from the privacy of your home at any time, day or night.
As a MyChart user, you are able to:
- Review past appointments
- Manage your prescription renewals
- Manage appointment requests and cancellations
- View your health summary, current list of medications and test results as released
by your doctor
- Receive important health reminders
- Manage the healthcare of your loved ones with MyChart - Caregiver.
MyChart licensed from Epic Systems Corporation© 1999-2010. Patents Pending.
- Visit: MyChart
Notice of Privacy Practices
At Cleveland Clinic, we believe your health information is personal. We keep records of the care and services that you receive at our facilities. We are committed to keeping your health information private, and we are required by law to respect your confidentiality. Our Notice of Privacy Practices describes the privacy practices of Cleveland Clinic and its affiliated facilities.
Health Information Exchanges with other Organizations
As described in the Cleveland Clinic Notice of Privacy Practices, Cleveland Clinic participates in certain health information exchanges (HIE’s) whereby we may disclose your health information, as permitted by law, to other health care providers or entities for treatment, payment, or health care operations purposes. A full list of these arrangements can be found on our Notice of Privacy Practices website.
Cleveland Clinic’s participation in HIE’s helps enhance the quality of your care. These HIE’s allow any health information organization that participates in the HIE’s to have secure electronic access to their patients’ records.
The goal of the HIE’s is to help participating physicians and providers give better, more efficient care to their patients by the sharing of health information across secure systems. This means that wherever a patient goes, the patient’s health information may be available to all doctors who use the HIE’s, which helps to provide safer, more coordinated patient care. Please notify your healthcare team at your appointment that you have been seen at another facility. If that facility also participates in the same HIE’s as Cleveland Clinic, Cleveland Clinic may be able to access and share your health information with these other participants for treatment purposes and for payment of treatment services.
For more information and to view participating healthcare organizations, please visit the health exchange partnership websites below:
You may opt out of the health information exchanges by doing one of the following:
- Send your request via email to CareEverywhere@ccf.org, with “Opt-Out” in the subject line; OR
- Mail your written request, signed and dated to the Cleveland Clinic Privacy Office, 9500 Euclid Ave/DD2-20, Cleveland, OH 44195
Include all of the following with your request so we can be sure to identify the correct medical information to restrict from all the Health Information Exchanges that Cleveland Clinic participate in:
- First and last name (and middle name, if applicable)
- Cleveland Clinic medical record number
- Date of birth
NOTICE: If you send health information to Cleveland Clinic via email, please know that your message may be sent in an unencrypted email. An unencrypted email means there is a risk that the information in the email and any attachments could potentially be read by a third party when it is sent through the internet.