Medical Record Information

Patient Requestors:

Deceased Patient

In order to release the medical records of a deceased patient, the requestor must provide a copy of the death certificate.  Medical records of a deceased patient may be requested by the personal representative of the patient’s estate.  If there is no spouse, a child of the deceased (or the parent, guardian or custodian of the child if the child is incompetent) may make a request.

Other acceptable documentation in lieu of a death certificate: Estate of executorship, letter of testamentary or probate court documents that show that an individual or other agent has been granted as the executor or administrator of the estate.

Healthcare Power of Attorney

Forms completed by the Healthcare Power of Attorney (POA) require a copy of the Healthcare POA paperwork and a physician statement citing that the patient is unable to make medical decisions.

NOTE: Power of Attorney is no longer valid once a patient is deceased.

Ways to request a copy of your medical record:

You may request your records to be printed, downloaded to a CD/DVD, or emailed.  A photo I.D. is required.

Mail or Fax

1. Download and complete the Authorization for Release of Information form.
2. Mail, fax, email form to HIM:

Cameron Memorial Community Hospital
Attn:  HIM Release of Information
416 E. Maumee St.
Angola, IN 46703
Fax: 260-665-7882
Email: medrecords@cameronmch.com

Visit Cameron Memorial Community Hospital

Release of Information office hours are Monday- Friday, 8:00AM  – 3:30PM, closed for lunch from 12:00PM to 12:30PM.

Records can be released to anyone that the patient authorizes (in writing along with photo I.D).  A valid authorization MUST be fully completed, witnessed, dated and signed or the request will be returned.

Depending on size of your request, you may be able to wait for copies.  We must have a completed authorization in order to begin processing your request.

Other Requestors:

For Healthcare Provider Requests

1. Fax your authorization or facility’s coversheet/letterhead to 260-665-7882. Please include the patient’s identifiers and a description of the information you are requesting.
2. Call 260-667-5500 to talk to a ROI tech.

For all other requestors (attorneys, insurance, 3rd party services, etc.)

1. Mail
2. Email your request letters with authorization to medrecords@cameronmch.com.
3. Fax 260-665-7882

Cameron Memorial Community Hospital
Attn:  HIM Release of Information
416 E. Maumee St.
Angola, IN 46703

Chart Correction Request:

Patients may request corrections be made to their charts. Please allow 30 days to process the chart correction request.  Please note that it can take up to 60 days as allowed by law.

Mail or Fax

1. Download and complete the Request for Amendment of Health Information form. If responding to a denied amendment request, download and complete the Statement of Disagreement.
2. Send a complete and signed form via email medrecords@cameronmch.com
3. Mail or fax the completed and signed form to our HIM department:

Cameron Memorial Community Hospital
Attn:  HIM Release of Information
416 Maumee St
Angola, IN 46703
Fax: 260-665-7882