Medical Record Information

Medical Record Information

Patient related information may be released to a physician or medical facility for follow up care free of charge. We encourage patients to request this information at least 7 to 10 days prior to any follow up visits.

Medical records must be complete before they are provided to the patient for personal use. A CD or PDF of your record is available upon request.

Medical Record Policy

Memorial Hospital of South Bend retains hospital based medical records in accordance with State of Indiana regulations.

All records are maintained for not less than 10 years following the date of discharge, after which they are destroyed. This applies to both inpatient and outpatient cases and to adults and minors.

How do I receive my Medical Record Information?

Step 1: Authorization Release Form

The information in the patient’s medical record is confidential. All requests for release of medical record information must be accompanied by an authorization signed by the patient. The form must have an original signature.

If you are an attorney in need of medical records, please call HealthPort at 574-647-2021 for more information.
PDF file

Download Authorization for the Use or Disclosure
of Protected Medical Information

Step 2: Submit

Complete the form, date and sign it. Please mail, fax (574-647-2022) or deliver in person as directed below:

Medical Record Department
Memorial Hospital of South Bend
Attention: Release of Information

615 N. Michigan St.
South Bend, IN 46601

When do I receive my Medical Record Information?

Memorial Hospital of South Bend has contracted with HealthPort to process patient requests for medical records. Patient information is processed within 7 to 10 business days. For questions, call HealthPort at 574-647-2021.

If information is needed more urgently for an appointment, contact the Medical Record Department directly at 574-647-7261.

Fees

Processing and copy fees are charged per Indiana Law.

  • Copy Costs
    Continuity of care copies of records to other health care providers will be forwarded directly at no charge. There is a charge for copies for personal use.
     
  • Disability
    Disability determination agencies are authorized to request and receive patient medical records. You may contact Disability directly for an application and they will request the records.

Contact Information

Memorial Hospital Medical Records

Monday - Friday
8 a.m. to 5 p.m.

Phone: 574-647-7261
Fax: 574-647-2022

HealthPort

Monday - Friday
8 a.m. to 4:30 p.m.

Phone: 574-647-2021