To request a copy of medical records for care received at Eskenazi Health, please complete an Authorization for Release of Confidential Information (also available in Spanish). Forms with instructions also are available in English and Spanish.
Please 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:
Attn: Release of Information (Eskenazi Health Information Management)
720 Eskenazi Ave.
Indianapolis, IN 46202
Eskenazi Health contracts with HealthPort for this service. The following fees apply to process your request. You will receive an invoice along with your records.
- Pages 1 – 10: each page $1.00
- Pages 11 – 50: each page $.50
- Pages 51+: each page $.25
- Plus postage and tax
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.