Request Medical Records

As a patient of Crossroad Health Center, you can request a copy of your medical records for your personal use or to obtain care from another health care provider. However, any release of your records – whether to you directly or to another person or organization – requires proper authorization to comply with our Notice of Privacy Practices. There is no fee for making copies of your medical records.

Authorization for releasing records may only be given by a:

  • Patient (not the spouse)
  • Power of attorney if the patient is unable to sign (legal document must be provided)
  • Parent (if the patient is younger than age 18)
  • Legal guardian (proof of guardianship document must be provided)
  • Representative of the estate for deceased patients (copy of the death certificate and a copy of the representative of estate documents must be provided)

If you would like to request your records, please talk to the patient representatives at the front desk. They can help you fill out the form. Record request forms are available in English and Spanish.

To print out the form, click here.

For any questions regarding medical record requests, please call Vivian Ewell, Quality Manager, at 513-381-2247, ext. 1601.