Medical Records Request

Thank you for choosing a Mercy facility to receive your medical care. If you find that you need access to or a copy of your medical records, please print and complete the appropriate form found at the bottom of this page. Mail the completed form to the Mercy facility where you received the service at the address listed.

If you need help to fill-out the release form, or to speak to someone regarding your request, or to set an appointment time to view your records, please use the hospital contact numbers listed below.

Records are kept off site so please allow time for processing. A picture ID is required when picking up medical records. If you select to have your medical records mailed to your home or to another location, a copy of your photo ID must be included with the mailed or faxed request.

Mercy St. Anne CDMC 947 S. Wheeling Oregon, OH 43616 Phone: 419-696-5527 Fax: 419-696-5510

Mercy St. Charles    CDMC 947 S. Wheeling Oregon, OH 43616    Phone: 419-696-7399 419-696-2502 Fax: 419-696-7702

Mercy St. Vincent CDMC 947 S. Wheeling Oregon, OH 43616 Phone: 419-696-5802 419-696-5572 Fax: 419-696-5570

Mercy Tiffin Health Information 45 St. Lawrence Dr. Tiffin, OH 44883 Phone: 419-455-7250 Fax: 419-455-7257

Mercy Willard Health Information 1100 Neal Zick Rd. Willard, OH 44890 Phone: 419-964-5050 Fax: 419-964-5061

Mercy Defiance Health Information 1404 East Second St. Defiance, OH 43512 Phone: 419-785-3994 Fax: 419-782-0219

Authorization/Request Forms
Mercy maintains adult medical records for 10 years from the date of service. Records for minors (under age 18) are maintained for 20 years.  To request copies of your personal medical records or the records of someone you have legal representation over, i.e. Minor Child, Guardian, POA, Executor of the Estate, Surviving Spouse, etc. use this form:
Request to Access Form

To have records sent to another party, i.e.physician, attorney, your spouse or another family member, use this form:
Authorization to Disclose