How to request medical records
To request a copy of your medical record or your child’s record for personal use, please choose an option below. Be sure to include:
- patient’s full name
- date of birth
- specific records requested
- treatment dates
- your name, address, phone number and relationship to the patient
Print the blank form, complete by hand and sign.
or
Complete the fillable (pdf) form using the required information above and sign using an e-signature (must include a photocopy of a government issued ID for proof), or print and hand sign.
Send completed forms by:
- fax: 330-543-5360
- email: records@akronchildrens.org
- postal mail:
ATTN: Health Information Management
Akron Children’s Hospital
One Perkins Square
Akron, OH 44308
All requests must be signed and dated.
Healthcare professionals may fax signed releases to: 330-543-3886
Copies for doctors and other care providers are free, otherwise customary charges will apply.
Call Health Information Management at 330-543-8552 for more information.
Sending records to Akron Children's Hospital?
Use one of the forms below.
Patient Name Change in Medical Record
The policy of Akron Children's Hospital is to maintain the first-registered patient name in the medical record until we receive legal documentation that allows a name change. Due to the timing of some patient registrations, we may have a name on file that has never been the legal name of you or your child. To ensure we have one patient per medical record, we require legal documentation to prove a name change in our system or correct any name discrepancies in the patient’s record.
If the patient's name in the medical record or MyChart does not match their current legal name, you may provide any of these documents to request a name change: birth certificate, court order, divorce decree, driver's license, finalized decree of adoption, marriage certificate, Medicaid insurance card, passport or social security card.
View our frequently asked questions below.
For more information, contact Health Information Management at DataIntegritySpecialists@akronchildrens.org or call 330-543-4244 between 7-4 p.m.
