Medical and Billing Record Release Forms
Use these forms when requesting transfer of your medical and billing records to or from another provider or to obtain a copy of your records:
- TriHealth (any entity) Authorization for Disclosure of Protected Health Information (PDF)
- Spanish Version (PDF)
Requests should be directed to the facility you were treated at.
Good Samaritan Hospitals
Phone: 513-862-2435, option 1
McCollough Hyde Memorial Hospital
TriHealth Physician PartnersClick here for a full list of TriHealth Locations
Other Medical Record Inquiries
If you have general medical record questions that cannot be answered by your physician practice or care team, the our online contact form can be used for other medical record inquiries. Select Medical Records from the Subject options on the form.