How to Request Records
- Complete the Authorization For Use and Disclosure of Protected Health Information Form(available below)
- Include a copy of a valid government issued ID
- If you are requesting information on the behalf of the patient or the patient is deceased one more of the following pieces of documentation is required:
- Court Order
- Proof of Power of Attorney
- Proof of Estate Executor
- If you elect to release your medical records to any other person(s) or entity please provide that information in Section 6 of the authorization, this includes Continuing Care Requests
*if you have any questions please contact us at: 606-430-3800
Requests may be submitted in one of the following ways:
By mail:
Pikeville Medical Center
Attn: Medical Records Department
Building G
155 Park Street
Pikeville, KY 41501
By fax:
(606) 218-4855
By email:
roi@pikevillehospital.org
The Medical Records Department is now open at its new location:
Medical Records
Pikeville Medical Center Building G
155 Park Street
Pikeville, KY 41501
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