An authorization to release a copy of a patient's medical record must be completed with the patient's name and date of birth. The authorization must be signed by the patient's legal guardian or the patient (if the patient is 18 years or older). Authorizations must be dated within one year of receipt are good for up to one year until completed. Once a valid authorization is received, we will respond to your request within 30 days.
There is a charge for receiving the complete medical record; all
charges are listed in the Charges section of this page. The
Complete Medical Record includes every piece of medical
documentation in the paper and electronic medical chart.
Documentation includes the following: Nursing documentation, Vital
statistics, Treatment Authorizations, Consents, Insurance Card
updates, Outside Medical Records scanned.
There is no charge for receiving pertinent information.
Pertinent documentation includes all documentation pertaining to
doctors' diagnoses, test results and treatment for the last two
Patients, parents or legal guardians may request
copies of medical records by using one of the release forms listed below.
If you want Children's Mercy to send
medical records to another organization, use the following
If you want another organization to send medical records to Children's Mercy,
use the following forms:
A separate authorization must be completed to
release copies of records from Developmental and Behavioral
Sciences and/or the Child Psychiatry Clinic:
Charges May Apply
|Standard Fees – Medical Records (Paper):
|| $24.57 labor and supply fee + $0.56 per page copied
|Standard Fees – Medical Records (CD):
|| $24.57 labor and supply fee + $0.56 per page copied, up to $107.67
|| $20 per disc
|| $5 per disc
The Health Information Department will mail you an invoice
before mailing the medical record request. You may pay by cash,
check, money order or credit card to the Children's Mercy cashier
located at each CMH location.
If copies are to be mailed to a doctor, hospital, or school, there
is no charge.