James W / Friday, February 9, 2018 / Categories: Patient & Visitor Information Request for Access to Protected Health Information Please complete the Request for Medical Records form to have a copy of your medical records sent to you or to someone other than yourself. Note: Parents and guardians, please use this form for your patients. Request for Access to Protected Health Information Authorization for Release of Information: Third parties, please complete the Authorization form to request a copy of an individual’s medical records. Note: The individual whose records are being requested must sign this authorization. Release of Information Authorization form Once you complete the form(s), you may fax it to 314-996-4410, or you may return to: Missouri Baptist Medical Center Attn: Health Information Management 3015 N. Ballas Rd. St. Louis, MO 63131 These documents are in PDF format and require Adobe Acrobat Reader. If you don’t have this software, go to Adobe for a free download. If you have any questions, call 314-996-5383 between 8 a.m. and 4:30 p.m. Monday through Friday. Print 50917 Rate this article: No rating