Release Form Availble in Spanish

The release of information authorization form is also available in Spanish.

Medical Records

E-Delivery Request Form

For patients requesting to have their medical records sent to them or someone else in an electronic format by Healthport, our Release of Information Company, please complete this e-delivery request form in addition to the general authorization to release form below. Please note, this is NOT connected to your IQ Health patient portal.

 

For Olathe Medical Center (OMC) patients:

Please complete this authorization form to request a copy of your medical records and return to the Health Information Management department at OMC. Read through this form carefully and be certain to fill out ALL areas of the form completely.  Failure to do so may mean that we will not be able to process your request.  If you need help with completing the form, please feel free to call us at 913-791-4200 ext.4632.  Once completed, you can fax the form back to us at 913-791-4335 or mail it to us at:

Health Information Management Department/Release of Information
Olathe Medical Center
20333 W. 151st Street
Olathe, KS  66061

To obtain a copy of your imaging records, please fax your request to: 913-791-4498.

Please note:  If the records you request total more than 10 pages, you will be charged $.60 per page (there is an additional fee for records stored on microfilm).  You will receive an invoice for these charges via mail from HealthPort, the Release of Information vendor used by Olathe Medical Center.  We are not able to send records directly to an insurance company or attorney’s office without a request from that office for the records.  The request must include a statement from the requester that they agree to pay for any charges incurred for the reproduction of the requested records.

 

For Miami County Medical Center (MCMC) patients:

Please complete this authorization form to request a copy of your medical records and return to the Health Information Management department at MCMC. Please read through this form carefully and be certain to fill out ALL areas of the form completely.  Failure to do so may mean that we will not be able to process your request.  If you need help with completing the form, please feel free to call us at 913-294-6703.  Once completed, you can fax the form back to us at 913-294-5919 or mail it to us at:

Health Information Management Department/Release of Information
Miami County Medical Center
2100 Baptiste Dr./P.O. Box 365
Paola, KS  66071

Please note:  You will be charged $.60 per page (there is an additional fee for records stored on microfilm).  You will receive an invoice for these charges via mail from HealthPort, the Release of Information vendor used by Miami County Medical Center.  We are not able to send records directly to an insurance company or attorney’s office without a request from that office for the records.  The request must include a statement from the requester that they agree to pay for any charges incurred for the reproduction of the requested records.

 

For Olathe Medical Services, Inc. (OMSI) patients:

If you have been a patient at one of the Olathe Medical Services (OMSI) clinics, please download and complete this authorization form and fax or mail it to your physician's clinic. To find the clinic's fax number or address, click on the OMSI clinic link above.