Request Medical Records

​To request a copy of your medical records from SSM Health St. Mary's Hospital in Jefferson City or in Mexico, Missouri, the Authorization for Release of Protected Patient Health Information form must be filled out and retu​​rned to the Health Information Management (HIM) Department. This requests includes medical records during the time when SSM Health St. Mary's Hospital - Audrain was known as Audrain Medical Center and when SSM Health St. Mary's Hospital - Jefferson City was known as St. Mary's Health Center.​

You can receive your SSM Health St. Mary's Hospital medical records in one of two ways:

  1. By mail – via the U.S. Postal Service
  2. By picking them up in person after making arrangements with Health Information Management (HIM).​


​Jefferson City campus​​

Audrain campus

By Mail

Print this form & mail to:

St. Mary's Hospital - Jefferson City
2505 Mission Drive
Attn:  Release of Information/HIM
Jefferson City MO  65109​

Print this form​ & mail to: 
St. Mary's Hospital - Audrain
620 East Monroe Street
Mexico, MO 65265 

By Fax

Print this form & fax to: 
option 1

Print this form​ & fax to: 

By Phone


option 1
Monday-Friday, 8 am - 5 pm CST

Monday-Friday, 8 am - 5 pm CST

Once We Receive Your Completed Authorization Forms... 

After the authorization form is filled out and received by our office we will send a copy of your medical records via U.S. Mail. The medical records may also be picked up by making arrangements with HIM. We do our best to expedite all requests, but in some instances an can take up to 30 business days to complete the request. ​


You can sign up to view your or your child's medical records from your computer or any smartphone. Learn more​ about this free and convenient service for our patients. There are some limitations to what can be viewed in MyChart. ​​

Frequently Asked Questions 

Do I need to send any sort of documentation along with the form? 
SSM Health takes patient privacy very seriously. Therefore, a copy of the patient’s legal guardian's ID is required to request medical records. We need this identification to verify that you are authorized to request the patient’s records. This can be a state-issued ID, birth certificate, etc. If you have any questions about what type of ID is accepted, please contact HIM. Read our privacy policy

How will I receive the records? 
You can receive the medical records in one of two ways: 
  1. By mail: via the U.S. Postal Service 
  2. By picking them up in person: after making arrangements with HIM 

Can I have the records sent along to someone else like a physician or specialist? 
Yes. In the second section of the authorization form, there is a place to indicate that you are authorizing SSM Health St. Mary's Hospital - Audrain or SSM Health St. Mary's Hospital - Jefferson City to disclose the medical records to a third party. 

If so, what information do you need from the third party: address, phone, etc.? 
In the case of disclosing medical records to a third party, we would need the name, address, phone, and fax (if applicable) of the third party. We would also need the relationship of the third party to your child (school, physician’s office, etc). 

Does it cost money to request my medical records? 
For personal requests, the cost depends on the number of pages requested. Printing costs start at 99 cents per page for smaller requests and as low as 33 cents per page for larger requests. You can also opt to have records stored on a DVD, which is half the cost of printing. In the case of personal requests, payment is required in advance of receiving the medical records. For requests being sent to a third party (i.e. continued care, insurance companies, or legal counsel), the fee will be paid for by that third party. Please be sure the third party is properly listed in the second section of the Authorization form. 

What sort of payment do you take? 
A bill will be sent to you once the records request is complete. If you are responsible for the payment, you may pay over the phone, by cashier’s check, credit card or money order. Or, you may pay at the hospital when you come to pick up your records. 

How can I be sure this is safe?
Providing correct information on the Authorization form is the first step in protecting your child’s confidential health care information. Be specific regarding the documents and dates that are to be released. Also, make sure any third party information listed on the Authorization form is correct; we will only release your child’s records to the parties listed on the form. We also use an encrypting method to ensure the security of your child’s private health care information.

    Before Selecting Your Appointment,

    there are some circumstances that require our assistance with scheduling.

    Please verify the following before proceeding:
    • I am age 35 or older.
    • I am NOT experiencing any issues, such as a lump, nipple discharge or other changes.
    • I was not diagnosed with breast cancer within the last three years.
    • I have not breast fed within the last six months.
    • It has been one year or more since my last appointment.
    If you have one or more of the above circumstances, please Connect By Phone. Otherwise, Confirm & Proceed.