Review Your Records

If you would like to review your Good Samaritan Hospital (GSH) medical record in person, you can make an appointment with the Medical Records/Health Information Management Services Department. Records must be reviewed in the presence of a Medical Records/Health Information Management Services Department employee. Appointments may be made Monday through Friday from 8:00 a.m. to 4:00 p.m., as available.
 
You must bring a photo ID. You may not remove any part of the record from the folder or make any changes. You can get a copy of your record for a reasonable fee.

Request a Correction

 If you need to make a change to your GSH medical record, you can use the Amendment Request Form. Complete the form, specifying what information you want amended, and then sign and return it to the Medical Records/Health Information Management Services Department. Either an approval or denial notice will be mailed to you after a decision has been made.

You can get this form one of two ways:

• Download it. To open the form you’ll need Adobe® Acrobat Reader®, which you can download for free. 
• Call the Medical Records/Health Information Management Services Department to request that the form be mailed to you: (937) 734-8316

Submitting an Amendment Request
 
Submit a signed copy of your amendment request form by mail, fax, or in person.

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