To request a copy of medical records for care received at Eskenazi Health, please complete a Patient Medical Records Access Request Form (also available in Spanish).
Pease return a completed authorization to Eskenazi Health in person, either to the hospital or your nearest Eskenazi Health Center location. It can also be returned via mail or fax to:
Eskenazi Health
Attn: Release of Information (Eskenazi Health Information Management)
720 Eskenazi Ave.
Indianapolis, IN 46202
Fax: 317.880.0469
Eskenazi Health contracts with Ciox Health for this service. The following fees apply to process your request. You will receive an invoice along with your records.
Produced/Requested Medium and Cost
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Format of original
patient record
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Cost for delivery in electronic formation
(CD/USB/download or portal)
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Cost for record delivered on paper.
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Electronic or Hybrid (part electronic, part paper)
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$6.50 flat fee for electronic portion
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Plus, if applicable, $0.07 per page
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Plus sales tax
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$0.07 per page for labor
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Plus, if applicable, the lower of the cost under state regulated patients rates or $0.90
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Plus $0.05 per page for supplies
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Plus postage, if mailed
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Plus sales tax
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Paper
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This process is in compliance with federal HIPAA guidelines. Please allow up to 30 business days for your records to be processed and mailed to your specified address.
Who is authorized to request release of medical records?
- The patient, if not a minor. For patients under age 18, a parent or parents may sign.
- The patient’s health care representative or Power of Attorney, if the patient is unable to sign – legal documents must be provided.
- Legal guardian if appropriate – documentation must be provided.
- Executor of an estate. For deceased patients, the executor of the estate is the first person who can request copies of records. Death certificates and estate documents must be presented.
For more information, please contact Eskenazi Health Information Management at 317.880.3454.