Contacting Our Medical Records Department:
- Phone: (989) 729-4503
- Email: m-health@MemorialHealthcare.org
- Hours: Monday through Friday from 7:30 am to 5:00 pm (excluding holidays).
If you are calling after business hours, please leave a message and we will return your call promptly the next business day.
We are located on the main campus of Memorial Healthcare, 826 W. King Street, Owosso, Michigan 48867
Please click here to download our Authorization to Release Information Form
Areas to be completed include:
- Patient’s Name
- Medical Record Number (can be left blank if unsure)
- Account Number (can be left blank if unsure)
- Date of Birth
- Date of Service (approximate if unsure)
#1: Fill in as Memorial Healthcare
#2: Fill in type of records requested – example: lab, x-ray, x-ray film, etc.
#4: Fill in name of person who will be picking up the record(s)
#5: Fill in where records will be taken – example: another physician, insurance, personal file
Patient or Legal Guardian must sign and date in the area provided (signature of patient or legal guardian required) and initial at I hereby acknowledge receipt of this authorization. Copy of legal guardianship papers must accompany signed Authorization.
Someone will need to witness the patient’s signature and sign/date in the area provided (signature of witness required).
Please do not attempt to e-mail this form. The original must be presented to or mailed to the Medical Records Department at 826 W. King Street, Owosso, MI, 48867.
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