Request Medical Records
Request for Access to Protected Health Information: Please complete this form to have a copy of your medical records sent to you or to someone other than yourself. Note: Parents and guardians, please use this form for your patients.
Authorization for Release of Information: Third parties, please complete this form to request a copy of an individual’s medical records. Note: The individual whose records are being requested must sign this authorization.
Print the above forms, complete them and mail them to:
Progress West Hospital
Health Information Management
ATTN: Release of Information
#2 Progress Point Parkway
O'Fallon, Missouri 63368 USA
If you'd prefer to fax, please fax the forms to 636-344-1046
If you have questions, call 636.344.1034 between 8 a.m. and 4 p.m., Monday through Friday.
Please note that a fee may apply.