Obtain an Authorization for Release of Information
form from the hospital or download and print the authorization form HERE
Fill out the form. Please print neatly and sign and date the form. Please make sure you indicate where you want the records to be sent, by checking the "release to" box, then note the person, organization and their address. If you would like the records to be faxed, you will need to note in the address section where the records are to be faxed and provide the fax number.
For hospital records, mail or fax the form. You may also call the office to discuss additional options.
- MAIL: ACMH Hospital, ATTN: Medical Records, One Nolte Drive, Kittanning, PA 16201
- FAX: 724-543-8498, Attn: Correspondence
- CALL: 724-543-8554 Monday through Friday, 7am - 2:30 pm
After your request is received, we will send you an invoice for the cost of the records you requested, if applicable. There is no fee to release records to doctors or health care facilities.
Send payment as indicated on the invoice. A convenient online payment option is available below.
After we receive payment, records will be mailed or faxed the following day. If you are picking up your records, government issued photo id is required to release them.
We’ve made it easy for you to pay for copies of medical records. Once you receive your invoice with the cost specified, use the link below to pay online. Note, if your invoice does not include a Request # that starts with A C M R , please do not make payment here.
RELEASE OF INFORMATION INVOICE, PAY HERE