Medical Records Request Forms

Stormont-Vail Authorization to Disclose/Obtain Health Information

Cotton-O’Neil Authorization to Disclose/Obtain Health Information

Stormont-Vail HealthCare will provide you with copies of your medical records if you authorize us to do so. There is a reasonable cost-based fee for obtaining record copies. 

If you are requesting copies of your hospital medical record for continuing your care, the copies can be mailed directly to your physician without charge. Please provide the physician’s name and address. 

Please allow a maximum of 30 business days to receive a response regarding your request. 

Mail or fax your hospital records request to: 

Stormont-Vail HealthCare
Release of Information
1500 SW 10th Ave.
Topeka, KS  66604
Fax: (785) 354-5119 

Mail or fax your clinic records request to: 

Cotton-O'Neil Clinic
Attn: Records Release
823 SW Mulvane St., LL, Suite A
Topeka, KS 66606
Fax: (785) 354-4268

Please see specific instructions on page two of the clinic records request form. 

Stormont-Vail HealthCare Billing Customer Service

Direct Phone (785) 354-6130
Toll-Free Outside Topeka Area (866) 327-3475
Email: BillingCustomerService@stormontvail.org


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