Request Medical Records
To download the following form, please click on the name and a new window will open with the form as a pdf document. You will need Acrobat Reader to open and print the form.
Request for Access or Copy of Patient’s Medical Record
The Health Information Management Department is glad to assist you with obtaining a copy of medical records from The Lindner Center of HOPE.
We need permission to process your request. Complete the Authorization for Release of Patient Protected Health Information form.
- For fastest service, choose Secure E-Mail for the Disclosure Method in section #5 on the form.
Send the form to us.
- For fastest service, email the authorization form to us.
- Email: firstname.lastname@example.org
- Fax: (513) 536-0219
Lindner Center of HOPE
Health Information Management
4075 Old Western Row Road.
Mason, Ohio 45040
Please allow 3-5 business days for a response to your request.
We do not have medical records for patients treated in the Cincinnati Children’s Hospital Medical Center Adolescent (CCHMC) care units at the Lindner Center of HOPE. Please contact Cincinnati Children’s. Phone (513) 636-4217 or fax (513) 636-6729.