- Patient Records Request - click here
- Third-Party Patient Records Request - click here
- Completed authorization forms can be scanned and emailed to: MedicalInfoRequests@independence.health
Or mail your completed forms to:
532 W. Pittsburgh Street
Attn: Medical Information Management
Greensburg, PA 15601
For questions, please call 724-832-4060.
For patients of Butler Memorial Hospital, Clarion Hospital and Butler Medical Providers:
You may obtain a copy of your complete medical record, including inpatient hospital visits and any outpatient and provider visits through the Medical Records Department Monday through Friday from 8 a.m. to 4 p.m. If you have any questions, call 724-284-4530.
Please complete the appropriate Authorization to Release Protected Health Information form and mail or fax to BHS medical records department. There is no charge to obtain your records.
Authorization to Release Protected Health Information form - click here
Butler Memorial Hospital Release of Information
Attn: Medical Records
One Hospital Way
Butler, PA 16001
(Fax) 724-284-4532
Proxy Request
You may appoint family members or other designated individuals to act on the patient’s behalf. Proxy access allows access to another’s record and features on behalf of the patient (such as making appointments, viewing appointments, viewing health summaries and billing information).
Proxy request forms must be signed by both the proxy and the patient and provide proof of guardianship to the medical records department.
- Proxy Request Form for children age 0 – 12 - click here
- My BHS Health Proxy Access: Adult Authorization Form - click here
My BMH Health Proxy Access: Power of Attorney/Legal Guardian Proxy Request Form- Adult Patient (For adult incapacitated patients) - click here
If requesting proxy access for a child age 12 or younger, please note, access must be re-established on the patient’s 13th birthday and 18th birthday with consent of both patient and proxy.
You can drop off your form by mail, all Proxy Request forms (with proof of identification) to:
Butler Memorial Hospital Release of Information
Attn: Medical Records
One Hospital Way
Butler, PA 16001
(Phone) 724-284-4530
(Fax) 724-284-4532
To remove a proxy, please complete the following form:
My BHS Health Proxy Access: Expiration/Removal Form - click here
