Medical Record Release
Copies of patient records are released upon request with a valid authorization signed by the
patient or legal representative, along with a copy of a valid photo ID (see list below).
If you are interested in obtaining a copy of your health information, please download,
print and complete the Authorization for Release of Protected Health Information form linked below.
The authorization may be faxed, mailed or delivered in person to the Health Information
Management Department at Grady Memorial Hospital.
If picking up requested records in person, bring one of the following forms of identification and
necessary documents (if applicable) to validate release of information:
Acceptable Photo IDs Include: driver’s license, employment ID, state issue ID, current
school ID, military ID, VA ID and valid, current passport
Other documents as applicable: power of attorney, legal guardianship papers and death certificate
For questions concerning completion of the authorization form, you may follow the link above or
contact Grady Memorial Hospital Health Information Management Department at 405-779-2875. or
405-779-2156.
Fax number: 405-779-2233 or 405-779-2111
Grady Memorial Hospital / 2220 Iowa Ave. / Chickasha, OK 73018 / (405) 224 - 2300
Contact Webmaster / Copyright © 2009 Grady Memorial Hospital / All rights reserved.
