To obtain copies of your medical records
1. Download and print a copy of the Release of Information Authorization form
- The authorization form must be signed and dated by the patient or the patient's representative before it can be processed.
- If the patient is a minor, the parent or legal guardian will need to sign for the patient.
- If the patient is deceased, a copy of the executor papers will need to be included with the authorization.
- If you have healthcare power of attorney for the patient, a copy must be submitted with the request.
Forms can be mailed to: Robinson Memorial Hospital
Attn: Health Information Management Department
6847 North Chestnut Street
Ravenna, OH 44266
2. Come to the Health Information Management Department and fill out the Authorization form in person. You must bring a state issued photo ID with you to obtain copies of your medical records. Copies of medical records sent directly to a physician are provided free of charge. However, there maybe a charge for copies provided for personal use in accordance with the Ohio Revised Code Section 3701.742. Fee list updated 1/1/13:
- $2.98 per page for the first 10 pages
- $0.62 cents per page for pages 11 through 50, and
- $0.26 cents per page after page 50
Usual wait time for records is 7-10 business days. Urgent requests should be made by a medical provider and will be fulfilled as quickly as possible. Your physician can fax your signed authorization to us at (330) 297-2309.
Request Radiology Imaging/films by calling (330) 297-2795
Requests Pathology Slides by calling (330) 297-2500
Robinson Health Affiliates, Inc. or other physician - contact that physician office
Health Information Management Department
6847 North Chestnut Street. Ravenna, OH 44266
Phone: (330) 297-2560
Fax: (330) 297-2309
Monday through Friday, 7a.m. to 5 p.m.