Dayton Children’s Hospital is legally required to receive specific authorization before medical records can be released. Authorization may be granted by completing an “Authorization for Release of Dayton Children’s Information” form. These forms are available through Health Information Management. Dayton Children’s charges when records are copied for personal use or for certain third party requests.

• Release of medical information
• Release of medical information (Spanish)

types of requests

Parents, guardians or patients 18 years of age and older are able to request multiple forms of records from Dayton Children’s. Please see below to ensure you are contacting the right department for your needs.

• Request for imaging CD only (X-ray, MRI, nuclear medicine or other films) should be received from the department of radiology and medical imaging at 937-641-3811.
• Request for billing- Dayton Children’s families are able to pay their bill online If you have a question or need an itemized billing statement please contact patient accounts at 937-641-3555.
• Request for copies of medical records should be directed to Health Information Management.