Request Records Online

The easiest way to request your medical records is through our secure online request process, which is managed by Datavant, WMMC’s release-of-information partner.

Request Your Medical Records Online

Follow the prompts to:

• Verify your identity
• Identify the records you need
• Select the dates of service
• Identify where the records should be sent
• Choose your preferred delivery method

Request Records Using a Paper Form

If you prefer to submit a paper request, download and complete the Authorization for Use and Disclosure of Protected Health Information (PHI).

Download the Authorization for Use and Disclosure PDF Form

Please complete all applicable sections and sign and date the authorization.

Return completed forms to:

Fax: (229) 228-2575

Mail or In Person:
Centro médico del oeste de Missouri
Medical Records Department
Calle Burkarth 403
Warrensburg, MO 64093

¿Preguntas? Call Medical Records at (660) 262-7395.

How Can I Receive My Records?

Depending on your request, records may be available through the following methods:

• Secure Email: Health information delivered electronically through a secure method.
• Unsecure Email: Patients requesting their own records may request delivery through unencrypted email after acknowledging the potential privacy risks associated with that delivery method.
• Mail: Paper records mailed to the address provided on your request.
• Fax: Records faxed to a healthcare provider or other recipient when appropriate.
• In Person: Records picked up in person. Photo identification may be required.

Requesting Records for a Minor

If the patient is a minor — age 18 or younger — the authorization must be signed by a parent or legally qualified representative. Proof of legal representation may be required when applicable.

Examples of documentation that may be requested include:

• Legal guardianship documentation
• Court orders
• Custody documentation
• Other documentation establishing legal authority to act on behalf of the minor

Additional requirements may apply when state or federal law allows a minor to consent to healthcare services or control access to certain health information.

If you are unsure who should sign the authorization, please contact Medical Records before submitting your request.

Power of Attorney or Personal Representative Requests

Examples of authorized representatives may include:

• Healthcare Power of Attorney
• Durable Power of Attorney that includes appropriate healthcare authority
• Court-appointed legal guardian
• Other legally authorized personal representative

Power of Attorney / Personal Representative Request

Please include documentation establishing your authority when submitting your request. Examples may include a Healthcare Power of Attorney, Durable Power of Attorney, guardianship documentation, court order or other documentation establishing legal authority.

The authority granted in a Power of Attorney can vary. WMMC will review the documentation to determine whether it provides authority to act on the patient’s behalf regarding the requested health information.

A financial Power of Attorney or other document that does not provide appropriate healthcare authority may not authorize access to a living patient’s medical records. Some Healthcare Power of Attorney documents become effective only when specific conditions are met, so additional documentation may be required.

If you are unsure whether your documentation is sufficient, please contact Medical Records.

Requesting Records for a Deceased Patient

Medical information remains protected after a patient’s death. To request medical records for a deceased patient, you must submit the required documentation for review.

Required Documents

Please submit:

• Authorization for Use and Disclosure of PHI
• Applicable Deceased Patient Next of Kin Affidavit
• Death Certificate
• Any additional documentation requested to establish authority, when applicable

Download the Authorization for Use and Disclosure PDF Form

Select the Appropriate Deceased Patient Affidavit

Select the affidavit that applies to your relationship or legal authority.

Free Notary Services Available: WMMC has notaries available free of charge to assist with completing and notarizing your affidavit. Please contact Medical Records if you need assistance.

Available affidavits:

• Deceased Patient Spouse Affidavit
• Deceased Patient Adult Child Affidavit
• Deceased Patient Adult Brother or Sister Affidavit
• Deceased Patient Parent Affidavit
• Deceased Patient Guardian or Conservator Affidavit
• Deceased Patient’s Child’s Guardian ad Litem Affidavit

When submitting your request, please also provide:

• Deceased patient’s full legal name
• Date of birth
• Date of death
• Records or dates of service being requested
• Your relationship to the deceased patient
• Tu información de contacto
• Identification or other supporting documentation, if requested

Being a spouse, child, parent, sibling or other family member does not automatically establish authority to receive a deceased patient’s complete medical record. WMMC will review the submitted documentation to determine whether the requested information may be released.

If you are unsure which affidavit applies or what documentation is required, please contact Medical Records before submitting your request.

Request Medical Images

If you need copies of X-rays, CT scans, MRIs or other diagnostic images, complete the WMMC Authorization for Use and Disclosure of PHI and submit the completed authorization directly to the Radiology Department.

Download the Authorization for Use and Disclosure PDF Form

Submit your completed authorization to:

Centro médico del oeste de Missouri
Radiology Department
Calle Burkarth 403
Warrensburg, MO 64093

Radiology Fax: (660) 747-2432

After your request is processed, you will receive access to your medical images through PocketHealth. PocketHealth provides a secure way to view, download and share diagnostic images.

Access Your Patient Portal

Many portions of your medical record may already be available through the WMMC Patient Portal. Depending on your visit and type of care, available information may include test results, visit information, clinical documents and other portions of your health record.

Access Your Patient Portal

Request an Amendment to Your Medical Record

If you believe information in your medical record is incorrect or incomplete, you may request an amendment. An amendment request is different from requesting a copy of your medical records.

Download Request for Amendment of Protected Health Information – PDF

Please identify:

• The specific information you believe is incorrect or incomplete
• Date of service, if known
• Provider or location involved
• What you believe the information should state
• Reason for the requested amendment

You may also submit supporting information.

An amendment does not generally remove the original documentation. If an amendment is accepted, the correction or additional information is added to or linked with the existing medical record.

WMMC will review your request and notify you of the decision.

Healthcare Providers Requesting Patient Information

Healthcare providers and healthcare facilities requesting patient information for treatment or continuity of care may submit a request through the provider request process.

Provider Requesting Patient Information

Please provide as much information as possible, including:

• Patient’s full legal name
• Date of birth
• Dates of service requested
• Specific records needed
• Requesting provider or facility name
• Phone number
• Fax number or other secure delivery information

For urgent continuity-of-care needs, please contact Medical Records directly.

Medical Records Phone: (660) 262-7395

Third Parties Requesting Patient Information

Attorneys, insurance companies, disability organizations, government agencies, employers and other businesses or organizations may submit requests for patient information through the third-party request process.

Submit a Third-Party Request Online

Third-party requests may also be submitted by fax, mail or in person to the WMMC Medical Records Department. Creating an account or submitting a request through SmartRequest is not required.

Requests must include all required documentation. Depending on the request, this may include:

• A valid Authorization for Use and Disclosure of PHI
• Documentation establishing legal authority, when applicable
• Other documentation required by applicable law

Submitting a request does not automatically authorize the release of a patient’s medical information. WMMC and its release-of-information partner will review the request and supporting documentation before records are released.

Subpoenas and Court Orders

Subpoenas and court orders must be served in person to the WMMC Medical Records Department for processing. They should not be submitted through the online third-party request process.

Health Information Privacy

WMMC is committed to protecting the privacy and security of your health information and helping you understand your rights regarding your medical record.

For more information about your health information and privacy rights, review WMMC’s Notice of Privacy Practices.

View Notice of Privacy Practices

If you have questions regarding the privacy of your health information, your rights or how your information may be used or disclosed, please contact the WMMC Privacy Officer at [email protected] or 660-262-7336.