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 (if the patient is 18
years or older) or the patient's legal guardian, and must be dated
within one year of receipt. Authorizations are good for up to one
year. Once a valid authorization is received, we will respond to
your request within 30 days.
Information Descriptions
Complete Record*
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.
Pertinent Information
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
years.
Forms
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
forms:
If you want another organization to send medical records to Children's Mercy,
use the following forms:
By law, a separate authorization must be completed to
release copies of records from Developmental and Behavioral
Sciences and/or the Child Psychiatry Clinic:
Charges
| |
Standard Fees - Medical Records Paper |
Standard Fees - Medical Records CD |
Radiology Images |
| Missouri* |
$21.39 Standard supply and labor fee
+ $.50 per page copied |
$5.15 per disk
+0.52 per page
Max charge: $25.77 |
$20.00 per disk |
| Kansas** |
$18.40 Standard supply and labor fee
+ $0.61 per page copied up to 250 pages
+$0.44 per page over 250 pages |
$5.15 per disk
+0.52 per page
Max charge: $25.77 |
$20.00 per disk |
*Missouri charges are based on Missouri House
Bill 1427 and Missouri Law 191.227 and 191.233, RSMo. (Effective
2/1/11)
**Kansas charges are based on Kansas Statute No. 65-4971.
(Effective 1/1/11)
Payment
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.
