Medical Record Requests

Request­ing Med­ical Records

We have part­nered with Medicopy, a ful­ly HIPAA com­pli­ant health infor­ma­tion retrieval com­pa­ny, to ful­fill the Med­ical Records Requests of our patients. Medicopy adheres to all state and fed­er­al reg­u­la­tions con­cern­ing the release of med­ical infor­ma­tion and requires the request be in writ­ing and signed either dig­i­tal­ly or manually. 

A request to obtain copies of your med­ical record can be completed: 

Online

• Com­plete the Autho­riza­tion for Release of Health Infor­ma­tion Form

By Paper Form

• If you pre­fer to com­plete a paper autho­riza­tion form, please down­load and print the Autho­riza­tion for Release of Health Infor­ma­tion Form.
• Sub­mit your com­plet­ed paper autho­riza­tion form to Medicopy by email­ing request@​medicopy.​net or by fax to 1−833−606−1226.

Please allow up to 30 days for pro­cess­ing.

Fees

Patients can request copies of their med­ical records at no cost if the deliv­ery method is via encrypt­ed email or to anoth­er provider out­side of The South Bend Clin­ic. Postage fees will apply for hard copy requests, so please ensure you sub­mit your email. If there is a fee for your request, Medicopy will pro­vide you with an invoice sum­ma­riz­ing the charges. Pay­ments can be made online http://​medicopy​.net/, over the phone by call­ing 1−866−587−6274 ext 215, or by mail­ing a check to the address list­ed on the invoice. All fees are in accor­dance with Indi­ana and fed­er­al law. 

Con­tin­u­a­tion of Care with oth­er Providers

All health­care facil­i­ties request­ing med­ical records must fax a request to The South Bend Clin­ic at (574) 204‑7656. Please send the patien­t’s name, date of birth, and the request­ed infor­ma­tion on your fax cov­er sheet. 

Learn more about MediCopy’s Release of Infor­ma­tion Ser­vice. If you have any ques­tions, please con­tact MediCopy: phone: 866−587−6274 | email: request@​medicopy.​net