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Health Information Management Department
Call - (330) 297-2560 Monday through Friday 7 a.m. - 5 p.m.
E-mail - Health Information Management Department
Stop in - The Health Information Management Department is located on the 1st floor of the hospital, just past the cafeteria.
How to obtain copies of your medical records
Information on your Robinson Memorial Hospital bill
Birth or Death Certificate & Paternity Affidavit Information
Social Security Number/Card Information
Advanced Directives (living will/durable power of attorney for healthcare)
TO OBTAIN COPIES OF MEDICAL RECORDS
Request Radiology Imaging/films by calling (330) 297-2795
Requests Pathology Slides by calling (330) 297-2500
Robinson Health Affiliates or other physician - contact that physician office
1. Download and print a copy of the Release of Information Authorization form
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The authorization form must be signed and dated by the patient or the patient's representative before it can be processed.
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If the patient is a minor, the parent or legal guardian will need to sign for the patient.
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If the patient is deceased, a copy of the executor papers will need to be included with the authorization.
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If you have healthcare power of attorney for the patient, a copy must be submitted with the request.
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Mail the form to:
Robinson Memorial Hospital
Attention: Health Information Management Department
6847 N. Chestnut St.
Ravenna, Ohio 44266
2. Come to the Health Information Management Department and fill out the Authorization form in person.
You must bring a photo ID with you to obtain copies of your medical records.
Copies of medical records sent directly to a physician are provided free of charge. However, there is a charge for copies provided for personal use in accordance with the Ohio Revised Code Section 3701.742.
Fee list updated 1/1/09:
$2.84 per page for the first 10 pages
$0.59 cents per page for pages 11 through 50, and
$0.24 cents per page after page 50
Usual wait time for records is 7-10 business days.
Urgent requests should be made by a medical provider and will be fulfilled as quickly as possible.
Your physician can fax your signed authorization to us at (330) 297-2309.
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PATIENT FINANCIAL SERVICES
Patient Financial Services can answer questions about your bill.
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BIRTH AND DEATH CERTIFICATES
To get a copy of a BIRTH CERTIFICATE or DEATH CERTIFICATE, you must contact the Ravenna Health Department:
Vital Statistics (330) 296-4478, Monday through Friday 8 a.m. - 4 p.m.
530 N. Freedom St. (SR 88), Ravenna, Ohio 44266
Certified copies of certificates can be obtained for a fee of $17 (last verified 1/1/09)
For more information on birth or death certificates from the State of Ohio Department of Health visit:
Ohio Department of Health and for frequently asked questions: FAQs at Ohio Department of Health
PATERNITY AFFIDAVITS
To get a copy of a paternity affidavit, contact the Ohio Paternity Enhancement Program.
For more information about paternity affidavits, visit: Ohio Paternity
or call 1-888-810-OHIO (6446), Monday through Friday 8 a.m. to 5 p.m.
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SOCIAL SECURITY NUMBERS/CARDS
Robinson Memorial Hospital does not issue Social Security numbers or cards. For more information, visit:
Social Security Administration
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ADVANCED DIRECTIVES/LIVING WILLS
Advance Directives are directions which you determine before you need them. They allow you to appoint someone as your health care agent and provide you the opportunity to state your wishes regarding health care treatment.
More information is available on the Robinson Memorial Hospital website under: Patient Information
Under Ohio law, there are two different forms you can use to make your wishes known:
Durable Power of Attorney for Healthcare – This form allows you to appoint someone as your agent to make all health care decisions for you, should you become terminally ill and unable to communicate, or temporarily or permanently unable to make decisions for yourself.
Living Will – This form allows you to give advance written directions about all of your health care decisions when you are terminally ill and unable to communicate, or in a permanently unconscious state. These documents are referred to as Advance Directives because they are signed in advance to let your doctor and others know your wishes concerning medical treatment.
Sample forms and more information can be found at Putitinwriting.org and OHA Advanced Directives or by contacting the Patient Advocate through the hospital operator (330) 297-0811.
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