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Medical Records



Records will be maintained and made available after receipt of a signed form that releases the medical record (your Protected Health Information) to another party or to yourself. 

Records Copying Process

  • Patient must sign a form for the release of records. Follow the link below to download a form. 
    • Authorization for Release of Protected Health Information (PHI)
  • Patient must present the form to the business. 
  • After the business receives the records a page count will be made and the copying fee will be determined (see schedule below). 
  • The patient will be informed of the fee. 
  • After receipt of the fee, the records will be copied and mailed to the stated party. 

Fee Schedule for Copying Records

The standard fees approved by the State of Ohio are charged for all records. Their web site is as follows: The fees below are for records requested by the  patient or their representative. Other fees may apply if a party other than the patient requests the records. 

Records will not be released without payment

  Cost Per Page
Pages 1 - 10  $2.67
Pages 11 - 50 $0.55
Pages after 50 $0.22
Postage Depends on Page Count

Forms To Release Medical Records



Copyright 2004-2006 Matthew G Schuermann, MD
Last modified: June 24, 2008