We’re happy to provide you with a copy of your medical record for follow-up care, insurance purposes or your own use. If you need your medical record for follow-up care or for another physician, please submit a completed authorization form at least 2 days in advance of your appointment.
A person requesting medical records must submit a written consent with the following information:
- Patient name, date of birth, contact information and last four digits of your SSN.
- Information being requested and dates of service.
- The name and address of the person the information is being released to.
- The signature of the patient, signed within one year, (signature must be notarized or witnessed by a Black River Medical Center employee).
Phone: (573) 712-2380
Hours: 8:00 am–5:00 pm, Monday-Friday
If you have questions regarding your billing statement, please refer to the Billing and Financial section of this web site.
To request a copy of your medical records from a physician who treated you, please contact the physician’s office directly.
If copies are going directly to a physician or hospital, there is no charge.
If copies of your medical records are to be sent directly to you, there is a fee as outlined below.
Payment for copies furnished: $10.00 for the first ten pages; $.54 cents per page for any remaining pages.
Release of information must comply with state and federal guidelines. Please contact our office if you have questions regarding the release of patient information.