You can obtain a paper copy of your medical records from Terre Haute Regional Hospital through our records partner CIOX. In order to request your medical record, download and complete a medical records release form, and then send to the address/fax number below.

Downloadable Patient Forms (PDF)

Mail Request Form:

ATTN: CIOX Release of Information
7300 Beaufont Spring Drive - Boulders VIII- Parallon
Richmond, VA 23225

Phone 877-302-7338

Fax Request Form:

Patient fax line 855-330-4290

Your medical records request will be filled within 7-10 business days, and we will inform you if we experience an unexpected delay. *Please note after the request is filled, delivery to your address may vary due to postal delivery times.

If you choose to receive your records by email, you should receive them much sooner.

Additional Information

For billing requests or billing records, please call 804-267-4000

For imaging results on a cd, please call the Radiology Department 812-237-1625.

*You will complete a separate release of information form that is marked for the imaging cd.

Request for Amendment of the Medical Records

If you would like to make a request to amend your medical records, please complete the Record Amendment Request and mail it to the Facility Privacy Officer in the Health Information Management department at:

Terre Haute Regional Hospital

Attn: Health Information Management
3901 South 7th Street
Terre Haute, IN 47802

Downloadable Record Amendment Request (PDF)

Any other needs, please contact the Health Information Management office at:

Terre Haute Regional Hospital
3901 South 7th Street
Terre Haute, IN 47802

Phone (812) 237-1604