Thank you for your interest in obtaining your medical record. In order for Ranken Jordan to release confidential medical record information to you or another person that you designate, please complete the request form available below, including your signature. Please print and complete the form and fax or mail it to the attention of Health Information Management at:
Ranken Jordan
11365 Dorsett Road
Maryland Heights, MO 63043
or Fax 314-872-6500
To minimize cost, we suggest requesting a copy of:
- Discharge summaries
- History & Physical
- Admission Assessments/Evaluations
- Immunization Records
We can only provide you a copy of the information we have. We cannot interpret what the information means or discuss it with you. Please take the information to your personal physician to discuss the findings.
Authorization for release of request of PHI HIM.pdf
*Our Medical Records Request Form is an Adobe Acrobat (PDF) document. If you are interested in downloading this file, but do not have Adobe Acrobat, you can download the program here.
