Please use this form to request access to your Protected Health Information (PHI) in the designated record set that we maintain.
You generally have the right to inspect and/or obtain a copy of your PHI in your designated record set from OSF HealthCare.
By law, we are not required to agree with your request for access to your PHI, and in certain situations, the law requires us to deny access.
If this is the situation, we will advise you of the reason for the denial. Under certain circumstances, you may be able to request a review of the denial.
If you request a copy of your records, OSF may charge a reasonable fee based on the cost of labor and materials to produce the copies.
If information contains sensitive information such as mental health/developmental disability, sexually transmitted diseases and/or alcohol/drug abuse, genetic testing or HIV/AIDS, please use our third-party authorization form process.
If you're attempting to submit the form below from a mobile device, you may receive an error. Please follow the link below to avoid any errors when submitting the request form.