Patient Access to Medical Information

You may request paper or electronic copies of your hospital or physician practice medical information. 

Complete the Patient Request for Access to Health Information form if you are the patient or representative of the patient (i.e. Healthcare Power of Attorney). Download form >>

Complete the Authorization for Use or Disclosure of Patient Information if you are a third party requesting information. Download form >>

You may send the appropriate request form via mail or fax:
Grand Lake Health System
Health Information Management
200 St. Clair Street
St. Marys, Ohio 45885

Fax: 419-394-3692

If you have any questions, please contact the Health Information Management department at 419-394-3387 extension 1115.