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.
