Medical Records

Pike County Memorial Hospital offers several simple ways to obtain your medical record.  We want you to have all the resources you need to manage your healthcare and offer the resources and assistance listed below.

Patient Portal
Our Patient Portal offers instant online access to your medical records from the convenience of your home or your phone.  To find out more about getting access to your Patient Portal, click HERE

In Person Request:

Our Health Information Management Department, or Medical Records, currently handles all record requests for Pike County Memorial Hospital and Clinics.  Our office is open Monday through Friday from 8:00 am to 4:30 pm and is located on the Second Floor of the Hospital.  You will need to bring a valid driver's license or photo ID for verification at the time of pick-up.  There is currently no charge for this service.

If you are unable to appear during our office hours, we would be happy to process your request and have them available for after-hours pick up at the Emergency Department Registration Desk.  This service is ONLY available for call-ahead requests. Our phone number is 573-754-5531.

Fax:

Our HIM Department can receive and send records via fax with a valid authorization.

Our fax number is: 573-754-6890

Mail:

You may mail your request to our HIM Department at:

Pike County Memorial Hospital                                                                                                                                                            ATTN:  Health Information Management                                                                                                                                              2305 Georgia Street                                                                                                                                                                      Louisiana, MO  63353

Transferring to Another Provider:

Your medical records can be faxed or mailed to the provider of your choice. Please let us know your appointment date so we can arrange for records to be delivered timely.

To Request Your or Your Child’s Records:

Patients and legal guardians, please click on the link below to request a copy of your medical records.
Note: Parents and legal guardians, please complete and sign the Authorization for Disclosure of Medical Record Information form for your children if they are under the age of 18.

Third Party Request:

To request a copy of your or your child’s records to be sent to a Third Party individual or organization, including your healthcare provider, please complete the Authorization for Release of Information form. Please submit the completed form to the address or fax number listed on the form.

Note: The individual patient (legal guardian for minor patients) whose records are being requested must sign this authorization.

Frequently Asked Questions

Can I have someone else pick up my records?

Yes, IF we have an Authorization to Disclose Protected Health Information signed by the patient granting that person access.  This form needs to be on file prior to the records being picked up.

Can I access my child's records if they are 18 or older?

No.  They will need to complete an Authorization to Disclose Protected Health Information form with your information in order for records to be released.

Can I access someone's medical records if I have Power of Attorney for Health Care (POAHC)?

Yes.  We will need to have a copy of the POAHC on file AND we will need to see a valid driver's license/photo ID when you pick up the records.  If these documents are not provided at the time of request, the request will be denied.

My relative is deceased.  Can I obtain a copy of their medical record?

Yes.  We will need a copy of the Death Certificate OR Power of Attorney for Health Care that specifically states you have access to records after death OR documentation/Will naming you as the Executor of the Estate.  In addition to one of the above documents, you will need to sign an affidavit stating your relationship you the deceased and provide a valid driver's license/photo ID for verification.

What if my question isn't listed here?

We encourage you to reach out directly to our HIM Department during business hours.  We are happy to assist you in any way we can!

Document Downloads

Privacy Practice Notice 

Release of Information Form

Authorization to Disclose Protected Health Information Form - Individual

 

Questions?

If you have any more questions about the services we render here at Pike County Memorial Hospital, please, don't hesitate to reach out.