How to submit

Once you’ve filled out the form, you can send it to the NMC Health HIM department by:

• Fax: 316.804.6261
• Email: medical.records@mynmchealth.org
• Mail: NMC Health
            HIM Department
            600 Medical Center Drive
            Newton, KS 67114

Requests are processed within 5-7 business days. Records may be picked up in-person between 8 a.m. and 4 p.m., Monday through Friday at NMC Health’s HIM office, located in the bottom of the NMC Health Surgery Center.

Records can only be released to the patient requesting them or the person specified under Section 2 of the release of information form. A valid photo ID is required for pickup.

Records may also be mailed to the patient or faxed to a physician.

How to fill out the form

Fill out the form by providing the following required information in each section:

• Section 1: Basic demographic information for the patient whose records are being requested
• Section 2: From whom the records need to be released (most likely from NMC Health)
  • Specify who needs to get the records (i.e. self, physician, insurance, spouse, attorney, etc.)
• Section 3: Explain why you need the records (i.e. personal, continued medical care, legal, etc.)
• Section 4: Verify how you’d like to receive the forms
  • Include the date range or specific dates with year that the treatment or services were performed
  • Include the type of record requested
• Section 5: Please read, print, sign and date the form

Allowable charges for record copying 

Effective January 1, 2011 the charges may not exceed $18.40 for supplies and labor, plus $0.61 per page for the first 250 pages, and $0.44 per page thereafter.