University of Toledo Medical Center


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Release for Medical Records

A patient, or his/her legal representative, may inspect and/or obtain a copy of their medical records, or have copies of medical records sent to another facility.

The University of Toledo Medical Center requires a completed and signed Authorization for Release of Health Information form before releasing any documents to anyone, including the patient.  In certain cases, a patient's physician, psychologist or social worker may also be required to approve a request.

If you have questions about this process, please feel free to contact the Health Information Management department directly at 419.383.4982

To Request a Copy of Your Medical Records

To submit your request once your form is completed, please bring form to:
Any UTMC registration area

Mail form to:
UTMC- ROI Office
1015 Research Drive, Mail Stop 1072
Toledo, Ohio 43614

Fax form to:
Attn: Release of Information

Release of Information Charges

  • No charges for records released to your physicain for continuing medical care.
  • $0.05 per page for supplies (paper and toner) Plus actual postage.
  • $0.90 flat labor fee to create EMR (electronic medical record).
  • $6.50 fee plus tax if record is delivered via e-delivery.
  • $5.00 fee for a personal copy of radiology images on CD.

Additional Information

  • If an individual other than the patient is picking up the records, then that individual must have an original signed authorization letter from the patient and along with a photo ID.  You may also be required to provide additional documentation to show that you have a legal right to request the record set.  Examples of these documents include: Letters of Representation; Guardianship Papers; Affidavits of Heir of Law; etc.
  • Please allow up to 7-10 business days for your request to be processed.  If you indicated the option to pick-up, you will be contacted by the Release of Information Office when your records are ready.  A photo ID is required.
  • Request an amendment and/or correction to protected health information.
  • Receive and accounting of disclosures of protected health information.


  • If you have questions regarding your billing statement, please contact 419.383.7400
  • For itemized billing statements, please contact 419.383.4982
  • For University of Toledo Physician's Billing Statement, please contact 419.383.7197

Radiology Images/EKG Films/Pathology Slides

If you are requesting radiology images, telemetry tapes or photos, you must contact the department that collected the data.

You can contact:

Patient Portal

Convenient, timely and secure access to your UTMC information.

Launch Portal
Last Updated: 2/28/20