Request for Access to Protected Health Information: Please complete this form to have a copy of your medical records sent to you or to someone other than yourself. Note: Parents and guardians, please use this form for your patients.
Download the Request for Access Protected Health Information form.
Authorization for Release of Information: Third parties, please complete this form to request a copy of an individual’s medical records. Note: The individual whose records are being requested must sign this authorization.
Download the Authorization for Release of Information form.
These documents are in PDF format and require Adobe Acrobat Reader. If you don't have this software, go to Adobe for a free download.
Once you complete the form(s), you may fax to 314.996.8772, or return in person or by mail to:
Barnes-Jewish West County Hospital
Attn: Health Information Management
12634 Olive Boulevard
Creve Coeur, MO 63141
|Health Information Management department:
|Fax for medical record request authorization forms:
Hours of Operation:
The Health Information Management department is staffed from 8 a.m. - 4:30 p.m., Monday through Friday