Request Medical Records

Request Personal Medical Records


The Health Information Management department is available Monday – Friday, 8:00 AM – 4:30 PM. To request copies of your medical records, please complete the Authorization for Release of Information.


This form may be submitted by:

Email: himstaff@rrhderby.com

Fax: 316-776-5702

Mail: 3251 North Rock Road
Derby, KS 67037
Telephone: 316-358-7850


Normal processing of requests takes 5-7 days. *If your request is urgent, or needed immediately please notate the top of the form. Please call our Release of Information Department at (316) 358-7850 with any questions.