Records, forms and certifications

Visit the My Record section under the Menu in MyChart for immediately downloadable health information to view and print you or your family members’ most commonly requested medical records and reports including: 

• Health summary: Medications, Allergies, Immunizations, Preventative care, and Current health issues
• Test results: View the results of your latest medical tests
• Past visits: Past visit summary and notes from your physician
• Complete visit summary: Download your complete visit history

You can specify the date range, which medical records, and the party receiving the copy of your medical records. Allow 5 business days for the completion of your request. Note that Hospital and Medical Office records released as part of this request may contain references related to mental health, addiction, and HIV conditions.

Request medical records.

Important:

For medical records requests made before August 20th, 2024 and September 17th, 2024, use the following page to track your requests.

For medical record requests made after September 17th, 2024, use the following page to track and download your requests for medical records in MyChart.

Your requests will be available for 90 days from the date you requested them.

Copay records for pharmacy and office visits 

You can review and download a cost summary of your copays for pharmacy and office visits. 
 
Itemized billing records

You can request an itemized summary of out-of-pocket costs you’ve paid for health care by following these steps: 

• Fill out an Authorization to Use and Disclose Protected Health Information form  (PDF)
• Send a secure message to your provider by clicking “Send a message” in MyChart. Select “Ask a Medical Question” and “Medical Records or Forms” as your topic.   
• Attach the Authorization to Use and Disclose Protected Health Information (PDF) to your message.

Please call Health Information Management Services for assistance. 

ROI assists your doctor with completing a Family Medical Leave Act (FMLA) certification request for a serious or chronic (ongoing) health condition.

You’ll need this information when submitting your FMLA request:

• Name of your employer
• Time frame

Please note that eligibility requires a minimum of 4 consecutive calendar days of leave or chronic intermittent leave periods such as 4 hours per week, 1 day per month, or a follow-up treatment schedule of leave. A work status request is not required for FMLA requests.

Request FMLA certification

Your requests will be available for 90 days from the date you requested them.

Track your requests for FMLA certification requests

We assist your physician in completing your disability certification.

• Before we can do this, you will need to:
  Discuss your disability and needs with your physician.
• Get a doctor’s note for the time you will need to be off work.

Once you have completed the above steps, send a secure message to your provider by clicking “Send a message” in MyChart. Select “Ask a Medical Question” and “Medical Records or Forms” as your topic.  You will need the following information to request disability certification:

• Condition (injury/ illness)
• Date of onset condition
• Date of upcoming surgery (if applicable)

Please call Health Information Management Services for assistance.

We can provide you with a doctor’s note or return-to-work form, allowing you to return to your job after an illness or injury.

Before we can do this, send a secure message to your provider by clicking “Send a message” in MyChart. Select “Ask a Medical Question” and “Doctor’s Note” as your topic. You will need the following information: 

• If there are any restrictions that need to be included. If yes, please state the specific restrictions.
• The type of work you do.
• The specific dates that your doctor’s note or return-to-work form pertains to.
• Attach any forms (if applicable).

Please call Health Information Management Services for assistance.

The medical records department can assist you with forms that you may need filled out for another organization.

To submit a form requiring assistance from another organization, take the following steps:

• Send a secure message to your provider by clicking “Send a message” in MyChart. Select “Ask a Medical Question” and “Medical Records or Forms” as your topic.
• Provide the specific condition or medication the form is for (if applicable).
• Attach the form to the message.

Once received, your request will be processed including obtaining any physician signatures.

View, download, and print commonly used forms, handbooks, and other publications. 

Important:

For medical records requests made before August 20th, 2024 and September 17th, 2024, use the following page to track your requests.

For medical record requests made after September 17th, 2024, use the following page to track and download your requests for medical records in MyChart.

Your requests will be available for 90 days from the date you requested them.