Obtaining a copy of your medical record is easy, simply download, print, complete and sign the authorization form and either fax or mail it back to us at the address listed below or stop by our department.
Please be sure to sign the form. Unsigned requests cannot be processed.
Our phone numbers
- Release of Information Desk: 620-252-1152
- Reception Desk: 620-252-1152
Our fax numbers
- Release of Information Desk: 620-252-1504
Our mailing address
Coffeyville Regional Medical Center
Health Information Management Department
Attention: Release of Information
1400 W. 4th St.
Coffeyville, KS 67337
Your request will be processed and fulfilled within 10 working days after receipt.
Frequently Asked Questions
(In all cases, please call the release of information desk to discuss your questions in greater detail.)