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HIPAA Medical Release Form

Medical Record Request / Authorization

Obtaining your personal health information is your right. Norton Healthcare is simplifying this process by allowing you to submit your request online.

Release of Information Form
Click on Complete Request below to submit an online release of information authorization. Once submitted, your request will be processed within 7 to 14 business day.
Complete Request >>

Submit Documentation
Supporting documentation may be indicated at the time of your request for release of medical information. You may now submit this required documentation online and a Health Information Management associate will verify and process the documents.
Submit Documentation >>

If you are unable to complete your request online, you can submit a form by submitting a request via MyChart, click on the Medical Record Request/Authorization Form or call 502.629.8766 and ask that a form be mailed to you. All records will be mailed or submitted to you via MyChart.

Medical record information will not be released over the telephone.

Contact Us
Health Information Management associates can be reached between the hours of 8:00am and 5:00pm, Monday through Friday, at (502) 629-8766.

Health Information Management
N16 P.O. Box 35070
Louisville, KY 40232-5070

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