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800 S. Washington Ave.
Saginaw, MI 48601
(click map for directions)

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Medical Records Request Form

Medical Records Request

How to obtain a copy of your records

Obtaining a copy of your St. Mary's of Michigan medical record is easy. To start your request, simply download, print, complete and sign the form on the right side of this page. Include a copy of our ID or Driver's License, and fax or mail it back to us, attention "Release of Information, Health Information Department (Medical Records)." Please be sure to complete the form it its entirety. Incomplete requests cannot be processed.

Our fax number is (989) 907-8697.

Our mailing address is: Release of InformationHealth Information Department (Medical Records) St. Mary's of Michigan 800 S. Washington Ave. Saginaw, MI 48601
Your request will be processed and fulfilled as soon as possible. We will either mail your copy to the address specified on the following authorization form (providing it matches your ID, and system demographics), or you may pick up your copy from our offices located at the address above between 8 a.m. and 4:30 p.m., Monday through Friday.
We do provide pertinent information free of charge. Pertinent information are reports that can be retrieved from our computer systems, such as radiology/imaging, history and physical, and discharge. There is per page copying fee for all other documents.

St. Mary's has the right to refuse to honor an authorization when the authorization is inadequate as defined by HIPAA, or if there is a question as to the authenticity of the signature. The responsibility lies with the requestor to prove he or she is legally able to authorize the release of records.

Should you wish to contact the Health Information Department (Medical Records), you may call
(989) 907-8081.

800 South Washington Avenue | Saginaw, MI 48601 |
(989) 907-8000 | 1-844-907-8000
` © 2016 AHIS / St. Mary's of Michigan