330-452-9911 (Aultman Main)
Patients & Visitors
- Patient Support
- My Experience
- Join Our Grateful Community
- Nondiscrimination & Language Services
- Patient Nutrition
- Patient Portal
- Patient Privacy
- Patient Medical Records
- Patient Rights and Responsibilities
- Patient Welcome Folder
- Tests & Procedures
- Contact Us
- Visitors
- Contact a Patient
- Aultman Anywhere App
- The Shoppes at Aultman
- Visitor Policies
- COVID-19 Information
- Parking and Maps
- Dining Options
- Things to Do
- Insurance and Billing
- Pay My Bill
- Insurance
- Financial Assistance
- Pricing
- FAQs
- Notice to Our Patients of a Privacy Incident
- Notice to Our Patients of a Privacy Incidents
Services
- Medical Services
- Back & Spine Center
- Birth Center
- Cancer Center
- Critical Care
- Emergency
- Heart & Vascular
- Mental Health Services
- Neurosurgery
- Orthopedics and Sports Medicine
- Stroke
- Surgical Services
- Urology
- Support Services
- AultmanNow
- Aultman Specialty Pharmacy Services
- AultWorks
- Case Management
- Clinical Trials
- Diabetes Education
- Grief
- Home Medical Supply
- Home and North Infusion Services
- Home Health Care
- Hospice/Palliative Care
- Imaging
- Inpatient Rehab
- Integrated Health Collaborative
- Lab
- MEDS Clinic
- Pain Management
- Security
- Sleep Services
- Spiritual Care
- Therapy
- Urgent Care
- Victims of Violence - Forensic Nurse
- Withdrawal Management
- Wound Care
Health & Wellness
About
- Aultman
- About Aultman
- Careers
- Diversity, Equity, Inclusion and Belonging at Aultman
- Newsroom
- Our Policies
- Annual Report
- Community Health Needs Assessment
- Sharon Lane – An American Heroine
- Aultman Corporate and In-kind Sponsorships
Locations
- Locations
- AultCare
- Aultman Alliance
- Aultman Carrollton
- Aultman College
- Aultman Dover
- Aultman Hartville
- Aultman Hospital
- Aultman Louisville
- Aultman Massillon
- Aultman Medical Group
- Aultman North
- Aultman Orrville
- Aultman Orrville Doylestown Health Center
- Aultman Tusc
- Aultman Tuscarawas Regional Health
- The Aultman Foundation
- Aultman Woodlawn
Schedule an Appointment
*Please fill in all the required fields.
- Home >
- Patients & Visitors >
- Patient Support >
- Patient Medical Records >
-
Access Request Form
Menu
Patient Support
- My Experience
- Join Our Grateful Community
- Nondiscrimination & Language Services
- Patient Nutrition
- Patient Portal
- Patient Privacy
- Patient Medical Records
- Patient Rights and Responsibilities
- Patient Welcome Folder
- Tests & Procedures
- Contact Us
Visitors
- Contact a Patient
- Aultman Anywhere App
- The Shoppes at Aultman
- Visitor Policies
- COVID-19 Information
- Parking and Maps
- Dining Options
- Things to Do
Insurance and Billing
Notice to Our Patients of a Privacy Incident
Location Finder
Here's your guide to finding any of the facilities in the Aultman family of health services, including maps and contacts.
Need a Doctor?
Aultman's network of providers is committed to high-quality patient care.
Schedule an Appointment
Click below to complete an online form.
Donate Today
You can help support and enhance services, and in turn, help patients and their families who benefit from care received at Aultman.
Access Request Form
Patients and patient representatives may use the online Access Request Form to request medical records from Aultman Hospital and Aultman Orrville Hospital. A few reminders before filling out the online form:
- If you are not the patient, you must provide additional information to verify that you are authorized to request the patient’s medical records.
- You must fill out a separate form for each person, such as a family member or doctor, who should receive the medical records. You will be able to select “Request another record” after you have completed the initial request.
- Have the following information on hand to complete the form:
- Driver’s license or government-issued photo ID; you will be asked to upload it.
- Your mailing address, email address and phone number.
- The address of the family member/caregiver, doctor or other party to whom we should release the records. - MRO will respond to your request for health information within 15 days of receipt of your request. If additional response time is required, we will notify you of the extension.
Please click here to start your request.
Location Finder
Here's your guide to finding any of the facilities in the Aultman family of health services, including maps and contacts.
Need a Doctor?
Aultman's network of providers is committed to high-quality patient care.
Schedule an Appointment
Click below to complete an online form.
Donate Today
You can help support and enhance services, and in turn, help patients and their families who benefit from care received at Aultman.