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Medical Information Release Form

Southwest General provides access to medical records to its patients in various ways. Patients and their Personal Representatives have the right to review and request amendments to their medical information. For more information regarding patients’ rights under the HIPAA laws, refer to our Notice of Privacy Practices webpage.

Request for Medical Records

Patients may access medical records in the following ways:

  • Use the HealtheLife patient portal.
    • Online access to portions of the electronic medical record 24/7/365. Setting up an account is free and takes only a few minutes.
    • Set Up Your HealtheLife Account here
  • Submit a written request to the Medical Records Department
    • Complete the Authorization to Disclose Health Information form by clicking here
    • Send to:
      • Southwest General - Medical Records Department
        18697 Bagley Road
        Middleburg Heights, Ohio 44130
    • Questions? Call 440-816-8480
  • Submit the above Authorization to Release Health Information form directly to the Southwest General Physician Office where services were received.

Request an Amendment to Medical Records

Patients have a right to request changes, or an amendment, to their medical record. For convenience, the following form may be used to submit a request to amend the medical record.

Amendment Request to Medical Information form