Request Medical Records

To request a copy of your medical records, download the Release of Information form (see below) and fax or mail it to the appropriate facility. Please be advised there may be a cost involved for this service.

-Release of Information form
-Release of Information form (Spanish version)

Veterans, Share your Medical Information With Us
. Download the VLER Health Program Factsheet.

Fax or mail completed form to:

Our Lady of Bellefonte Hospital
1000 St. Christopher Drive
Ashland, KY 41101

606-833-3140 fax