Request Medical Records

To send via fax or mail, please download, print and complete the Authorization for Release form:

Please note that Ranken Jordan HIM can only provide a copy of the information on file. We cannot interpret what the information means or discuss it with you. If you have additional questions about the content of the records, we encourage you to contact your doctor or the treating physician.

Ranken Jordan is committed to your privacy. Read about HIPAA and your privacy.