Below you will find the forms necessary to get your records released from Iron Mountain due to a hospital closing. 

• Deaconess Hospital Patients
• Former St. Francis Health System (and the former Central Medical Hospital) Patients
• Former Patients of New York United Hospital
• HomeCall Pharmaceutical / HomeCall Rx / HomeCall Infusion

Information for Former Deaconess Hospital Patients

How to Request Your Medical Records or Radiology Films

Please complete the appropriate authorization form in its entirety. All incomplete requests will be returned to the requester, and will result in a delay of your request.

Return the completed form(s) (a prepayment request for medical records will be sent to you prior to the copies being released, Ohio Legislation regulates these fees. If you are requesting Radiology films, these fees are set at $25.00 retrieval/delivery fee for radiology films, which may be included in your request) to:

Iron Mountain
Attn: Correspondence Department
1600 West Carson Street
Pittsburgh, PA 15203
(412) 481-4134

• FAQ for Former Deaconess Hospital Patients
• Authorization for Release of Information - Deaconess
  

Information for Former St. Francis Health System (and the former Central Medical Hospital) Patients

How to Request Your Medical Records or Radiology Films

Please complete the appropriate authorization form in its entirety. All incomplete requests will be returned to the requester, and will result in a delay of your request.

Return the completed form(s) and payment ($25.00 retrieval fee for medical records and/or $25.00  fee for radiology films) to:

Iron Mountain
1739 East Carson Street, #362
Pittsburgh, PA 15203
(412) 481-4134

• Authorization for Release of Information for Former St. Francis Medical Center   

Information for Former Patients of New York United Hospital

How to Request Your Medical Records or Radiology Films

Please complete the appropriate authorization form in its entirety. All incomplete requests will be returned to the requester, and will result in a delay of your request.

Return the completed form(s) (a prepayment request for medical records will be sent to you prior to the copies being released, Ohio Legislation regulates these fees. If you are requesting Radiology films, these fees are set at $25.00 retrieval/delivery fee for radiology films, which may be included in your request) to:

Iron Mountain
Attn: Customer Service
P.O. Box 477
Route 9W
Port Ewen, NY 12466
(845)338-2993

• Release of Radiology/Mammograms Forms
• FAQ for Former Patients of New York United Hospital

Information for HomeCall Pharmaceutical / HomeCall Rx / HomeCall Infusion for Release of Health Information

In order for this authorization to be considered valid, it must be completed in its entirety.

Mail completed authorization to:
Iron Mountain
Imaging/ROI Department
8200 Preston Court
Jessup, MD, 20794
410-792-0136 ext. 242 (phone)
410-792-0799 (fax)

• Authorization for Release of Health Information
• FAQ for Former HomeCall Pharmaceutical / HomeCall Rx / HomeCall Infusion Patients