How do I get a copy of my medical records?
If your hometown physician or a medical specialist requests a copy of your Sindecuse Health Center medical record, you must sign an authorization before we can send it. Information from your medical record is never shared with any area of the University, or with any administrator, faculty or staff member without your written consent, except as required.
Medical records requests are processed as promptly as possible but requests should be made as early as possible. Our normal turnaround is seven to 14 days, but wait time may extend up to 30 days depending on the number of requests we are processing. Authorization forms may also be obtained from the health care provider requesting your records. This form asks you to identify the physician or medical office requesting the records.
Print the Release of Information (Authorization) form and fill the front side out completely according to the instructions below.
- Fill in all identification information on the top four lines.
- If Sindecuse will be sending information to another person/provider, circle "from" Sindecuse and "to" the person/provider. Please fill in the complete address, telephone, and fax numbers.
- If Sindecuse will be receiving information from another person/provider, circle "to" Sindecuse and "from" the other provider. Please fill in the complete address, telephone, and fax numbers.
- Check the box beside the parts of the medical record you want sent or requested. If you are not sure of what parts should be checked, please leave a message for us at (269) 387-3283.
- Check in the box regarding the purpose for this request.
This authorization is good for one year. You may change this time by filling in another date or event (e.g. graduation from WMU). If you are 18 or older, be sure to sign and date the form.
If you are under 18, a parent or guardian must sign and date the form and list the relationship to the patient. This release of information becomes invalid on the patient's 18th birthday.
- Fax this form to (269) 387-4494, Attn: Medical Records
- Or, mail it to:
Sindecuse Health Center
Western Michigan University
1903 W Michigan Ave
Kalamazoo MI 49008-5445
- Or, bring the signed authorization and a picture ID to Sindecuse Health Center.
HIPAA and Privacy at the health center.
Our Notice of Privacy Practices (PDF linked here) describes how your medical information may be used and disclosed and how you can get access to this information. It outlines responsibilities relating to the Health Insurance Portability and Accountability Act. If after reviewing our privacy practices, you have questions or concerns, please contact one of the following HIPAA officers with responsibility for the health center.
Security Officer: Pete Poggione
Privacy Officer: Keith Hahn
Compliance Officer: Mark P. Broeckel