Release Medical Records

INTEGRIS Health releases copies of patient records upon request provided we receive a written request or valid authorization signed by the patient or legal representative.

Release of Information

INTEGRIS Health releases copies of patient records upon request provided we receive a written request or valid authorization signed by the patient or legal representative.

Patient or Patient Representative Request Form

This form should be utilized to request copies of your own information or to direct copies of your information be sent to a third party.

Patient Authorization

This form should be utilized to authorize a third party to obtain copies of your health information upon on the third party’s request.

The “Patient Request for Health Information" or the “Authorization for Release of Health Information” forms may be submitted to INTEGRIS utilizing one of the following methods:

Mail: INTEGRIS HIM Department
3366 NW Expressway, Building D Ste. C20
Oklahoma City, OK 73112

Fax: INTEGRIS HIM Department
405-552-8704

Personal Delivery to any INTEGRIS Health location.

If picking up your requested records, INTEGRIS will validate identity by signature or by one of the following forms of identification:

Acceptable IDs Include:

  • Driver's license
  • Employment ID
  • State Issue ID
  • Current School ID
  • Military ID
  • VA ID
  • Valid, Current Passport

Personal Representatives should provide documentation to prove legal representation such as:

  • Power of attorney for healthcare
  • Legal guardianship papers
  • Order of legal representation

Medical record copy fees may be applied as below pursuant to federal regulation 45 CFR 164.524(c)(4).

  • Patient or patient representative requests:
    • Electronic Delivery: Flat rate fee of $6.50 if records are in electronic format and delivered on electronic media. In addition, $0.12 per page if any of the records are maintained on paper.
    • Paper Delivery: $0.12 per page plus labor cost, shipping supplies, actual postage, and sales tax.
  • 3rd party requests (i.e. attorneys or insurance companies):
    • $10.00 flat fee plus $0.30 per page for paper or electronic delivery. Total charges are capped at $200 if the entire request can be reproduced from an electronic health record in the specified format requested and delivered electronically.

X-rays, photographs, images, or pathology slides are a flat rate of $5.00 each.

Please allow up to 30 days from the date of discharge for record processing before requested copies will be available.

Questions? Please call Health Information Management at 877-778-7211

Additional Forms