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Medical Records

The Health Information Management Department (HIM) ensures that a complete and accurate medical record is maintained for every patient visit and is committed to ensure your information is kept secure and confidential. HIM has a centralized release of information process so that you can obtain your medical records from any T.J. Regional Health location by simply contacting any HIM location below.

The main HIM Department is located in T. J. Samson Community Hospital and open Monday – Friday from 6:00 am until 4:00 pm and closed on weekends and holidays.

The Pavilion / Clinic HIM Department is located in the T. J. Health Pavilion and open Monday – Friday from 7:00 am until 4:00 pm and closed on weekends and holidays.

After hours, customers may leave a voicemail message and your call will be returned on the next business day.

How to get printed copies of your medical records

Your doctor may request your records. The doctor’s office should call the appropriate phone number in the Contact Us section to request your medical records. We will fax the requested records directly to your doctor prior to your appointment. This is the quickest way for your doctor to receive your medical records.

You may request your records by filling out an authorization form in person at any Health Information Management Department location.

You may print the authorization form and mail or fax it. Click the button below to download the form. If sending via fax, choose the appropriate fax number from the Contact Us section on the right side of the page.

Authorization Form for Download

RIGHT TO AMEND: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by, or for, TJRH. In your written request, you must provide a reason that supports your request for amendment. If we approve your request, we shall make the amendment to your medical information, inform you that we have made the amendment, and make a reasonable effort to tell others that need to know about the change to your medical information.

  1. Submit electronic form or mail request to: Compliance Officer at TJRH, 1301 North Race Street, Glasgow, KY 42141
  2. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
    • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
    • Is not part of the medical information kept for or by TJRH;
    • Is not part of the information which you would be permitted to inspect and copy; or
    • Is accurate and complete.

If your request for amendment is denied, we will provide you with a written statement of the basis for the denial and a description of how you may file a written statement of disagreement. If you do not file a statement of disagreement, you may request that your request for amendment and our written denial be provided with any future disclosures of your medical information.

Request for Amendment of Medical Records for Download