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 Ciox, 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 IQHealth 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 required areas of the form completely. Failure to do so may mean that we will not be able to process your request. You may also submit a written request, signed and dated, which clearly identifies the designated person/location to send the copy of your medical records. If you need help with completing the form or if you have questions, 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, deliver in person, or mail it to us at:

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

Please note: You may be charged a cost-based fee. You may receive an invoice for these charges via mail from Ciox, the Release of Information company used by Olathe Medical Center.

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

 

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. Read through this form carefully and be certain to fill out ALL required areas of the form completely. Failure to do so may mean that we will not be able to process your request. You may also submit a written request, signed and dated, which clearly identifies the designated person/location to send the copy of your medical records. If you need help with completing the form or if you have questions, please feel free to call us at 913-294-6703. Once completed, you can fax the form back to us at 913-294-5919, deliver in person, 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 may be charged a cost-based fee. You may receive an invoice for these charges via mail from Ciox, the Release of Information company used by Miami County Medical Center.

 

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, deliver in person, or mail it to your physician's clinic. To find the clinic's fax number or address, click on the OMSI clinic link above. Please read through this form carefully and be certain to fill out ALL required areas of the form completely. Failure to do so may mean that we will not be able to process your request. You may also submit a written request, signed and dated, which clearly identifies the designated person/location to send the copy of your medical records.

If you need help with completing the form or if you have questions, please feel free to call us at 913-782-2974.

Please note: You may be charged a cost-based fee. You may receive an invoice for these charges via mail from Ciox, the Release of Information company used by Olathe Medical Services clinics.