Medical and Billing Record Release Forms

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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:

Requests should be directed to the facility you were treated at.

Bethesda Hospitals

Email: thbethesdanorthmedrec@trihealth.com
Phone: 513-865-1101
Fax: 513-865-1392

Good Samaritan Hospitals

Email: gshmedrecords@trihealth.com
Phone: 513-862-2435, option 1
Fax: 513-862-2628

McCollough Hyde Memorial Hospital

Email: mhmedrecords@trihealth.com
Phone: 513-524-5419
Fax: 513-254-5419

TriHealth Physician Partners

  Click 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. 

Other Forms

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