Request to Access Protected Health Information

You have the right to request to inspect the protected health information in records that UMCF creates or maintains. You also have the right to request copies of those records.

Fees: You may be charged for the cost of copying and postage.

Response time: We will respond to your request within 30 days after we receive it.

Receiving Your Records

If you want records mailed

Include with your completed form:

A photocopy of your Ohio driver’s license, an ID card issued by the Department of Motor Vehicles, or other valid identification
Documentation verifying your address

Mail/Fax the completed form to one of the following locations

Dayton Area

1785 Big Hill Rd.
Dayton, OH 45439
Fax: (937) 264-0095

Columbus Area

431 E. Broad St.
Columbus, OH 43215
Fax: (614) 885-4058

If you prefer to come in person

Bring the completed form
Call ahead to schedule with admin staff using the phone number below
Bring your photo ID and proof of address
If custody paperwork applies, please bring the relevant documentation with you

Healthcare Providers

If you are a healthcare provider requesting medical records for continuity of care, please submit your request in writing on official letterhead. Include the client’s full name, date of birth, specific records requested, purpose of the request, and a valid HIPAA-compliant authorization. Requests may be sent via fax or secure email as listed below.