University of Toledo Medical Center

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Release of Medical Records

For most purposes, The University of Toledo Medical Center requires a completed and hand-signed Authorization for Release of Health Information form in order to release medical records.  

However, we can send non-Psych, non-substance use records to a healthcare provider without this authorization for continuation of care. Their office may fax a request to 419-383-3001 on their coversheet containing your name, date of birth, and the specific information they need.

If you have questions about this process, please feel free to contact the Health Information Management department directly at 419.383.4982. The message on this phone line gives this information as well.

To Request a Copy of Your Medical Records

To request records not related to Part 2 (information below), print and complete page 1 of the Authorization for Disclosure of Health Information.Page 2 is informational only.

  • The form must be hand-signed & dated, with every section completed as specific as possible. Incomplete forms may cause a delay in processing.
  • If you are unsure which records to request -
    • For inpatient admissions/procedures: You may request a “pertinent package” containing the most relevant healthcare information: Discharge Summary, procedure reports, History and Physical, Consultations, and available testing.
    • For outpatient services: the last 2 years of outpatient office visits & available testing are the most relevant.

To request substance use and/or substance abuse treatment (Part 2) records, print and complete the Part 2 Consent to Release in addition to the Authorization for Disclosure form above. The form must also be hand-signed & dated, with every section completed as specific as possible.

To submit your completed forms:

Bring physical form to:
Any UTMC registration point

Mail form to:
UTMC- ROI Office
1015 Research Drive, Mail Stop 1072
Toledo, Ohio 43614

Email form to:
HealthInfoMgmtROI@utoledo.edu

  • You may attach a scan or a legible digital picture of the completed forms

Fax form to:
419.383.3001

Release of Information Charges

There is no charge to release records to a healthcare facility for continuing medical care, or for copies of immunizations.

Paper copies: $0.07 per page for supplies (paper and toner) plus postage, and $0.90 flat labor fee

Electronic delivery (email or CD): $6.50 flat fee plus tax for any number of pages

Additional Information

  • If someone other than the patient is picking up records, they must have an original patient-signed authorization (noting this person is ok to pick up), and a photo ID. 
  • If you are requesting the medical records of someone else, you may be asked to provide additional documentation. This may include Guardianship, Healthcare Power of Attorney, etc. If the patient is deceased, we will require the Death Certificate, with documentation of the personal representative. This may be Executor, Last Will and Testament, etc.
  • Please allow up to 7-10 business days for your request to be processed.
  • Request an amendment and/or correction to protected health information.
  • Receive and accounting of disclosures of protected health information.

Billing

  • To request University of Toledo Medical Center billing statements or discuss their bills, please contact 1.888.444.0476
  • To request University of Toledo Physicians billing statements or discuss their bills, please contact 419.383.7197 

Radiology Images/EKG Films/Pathology Slides

CD of Radiology images:

  • $5.00 fee for a personal copy
  • There is no charge if taking to a healthcare provider. Provider name must be entered in the “Send to” section of the request.

If you are requesting telemetry tapes or photos, you must contact the department that collected that data.

The contacts for these departments are below:

Last Updated: 8/12/24