Although the physical medical record is the property of Lima
Memorial Hospital, the information contained within belongs to you,
the patient. You have the right to see and get a copy of
To obtain copies of your medical records, click on the link below
to print the Release of Medical Information Form. Complete
the form, paying close attention to the following areas which need
completed in their entirety:
- Patient Name
- Patient Address
- Patient Phone Number
- Patient Social Security Number
- Patient Date of Birth
- Date of Service (Approximate if necessary)
- Type of Information Requested
- Purpose of Disclosure
- Sign, Date, and Witnessed
Here to Download the Release of Medical Information
Send the completed form, along with a copy of your photo
ID to the following address or fax:
Lima Memorial Health System
Attn: Medical Records
1001 Bellefontaine Ave.
Lima, OH 45804
Fax: (419) 226-5061
Phone: (419) 226-5025
If you are planning to pick up the records, "Information
Released/Exchanged To:" may be left blank.
- There may be a charge for copies of records.
- Processing record requests may take at least 48 hours.