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Medical Records Requests from Patients To obtain a copy of your medical record from St. John's Mercy Medical Group, please complete our Request for Access to Health Information Form and mail or fax the completed form to your SJMMG physician's office. SJMMG may charge you a reasonable per page copy charge allowed under Missouri law and a postage charge (if applicable). A handling fee will not be charged for patients requesting a copy of their record. Authorization for Use and Disclosure of Protected Health Information If you would like St. John's Mercy Medical Group to release your medical record to a third-party, please complete our Authorization for Use and Disclosure of Protected Health Information and mail or fax the completed form to your SJMMG physician's office. For medical record requests from sources other than patients (e.g., attorney’s, insurance companies), SJMMG may charge $18.49 plus $0.44 per page for the cost of supplies and labor (effective 2/1/07). If you have questions or
would like additional information regarding your medical record, please contact
your SJMMG physician's office.
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Sisters of Mercy Health System
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