To request a copy of your medical record, complete the Release of Information Authorization (English) or Autorización de Divulgación de Información (Español) form and return to the Medical Records Department at JCDHE. Read this form carefully and fill out ALL areas completely. If your form is incomplete, JCDHE will not be able to process your request. If you need help completing the form, call 913-826-1200 or send your request to [email protected]. Fax your completed form to 913-826-1300 or mail to:
Johnson County Department of Health and Environment
11875 S. Sunset Drive, Suite 300
Olathe, KS 66061
The first 10 pages are free. If records are more than 10 pages, pages 11 up to 250 will be billed at the state per-page rate of $.63 per page (per K.S.A. 65-4971(b), thereafter $.45 per page plus $18.97 for shipping and handling. NOTE: Rates are subject to change with review of the Consumer Price Index. Turnaround time is usually 10 business days or less but can take up to 30 days.
Requests from insurance companies or law firms must include a signed release. A statement from the requester agreeing to pay for any charges incurred for the reproduction of the records is also required.