Home
Forms Library
The Kettering Health Network (Hospital) authorization form

The Kettering Health Network (Hospital) authorization form 2025

The Kettering Health Network (Hospital) authorization form Preview on Page 1

Show details

4.3 out of 5

27 votes

The document is a request form for the disclosure of protected health information from Kettering Health Network. It includes patient details, the purpose of the request, types of health information to be disclosed, and authorization for release. The form also outlines potential fees for copies and provides contact information for the Release of Information Department.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

The easiest way to edit The Kettering Health Network (Hospital) authorization form in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Adjusting paperwork with our comprehensive and user-friendly PDF editor is easy. Follow the instructions below to fill out The Kettering Health Network (Hospital) authorization form online quickly and easily:

Log in to your account. Sign up with your email and password or register a free account to try the product before choosing the subscription.
Import a document. Drag and drop the file from your device or import it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit The Kettering Health Network (Hospital) authorization form. Effortlessly add and highlight text, insert images, checkmarks, and icons, drop new fillable fields, and rearrange or remove pages from your paperwork.
Get the The Kettering Health Network (Hospital) authorization form completed. Download your modified document, export it to the cloud, print it from the editor, or share it with other people using a Shareable link or as an email attachment.

Make the most of DocHub, one of the most easy-to-use editors to rapidly handle your documentation online!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I contact Kettering Health Network?

Call (866) 319-2981 to speak to a billing customer service representative with questions about your bill, financial responsibility, cost of service, insurance, and more.

How do I get my medical records from Kettering Health Network?

Access to your medical records or the medical records of a loved one is a necessary quality to receiving care. If you need information about your medical record or need to obtain yours or a family members, please call (937) 752-2200 or visit Medical Records.

How do I get my medical records from Sloan Kettering?

You can also request a copy of your results, notes, and records by contacting MSKs Release of Information department by phone at 646-227-2089 or email HIMROI@mskcc.org. There are several ways to ask for (request) your MSK medical records. In MSK MyChart, go to Sharing Hub.

What is a hospital authorization form?

Patient privacy protection: A HIPAA authorization form allows patients to decide who can access their health information, promoting privacy and control over their medical records.

Is there a way to access your medical records online?

Online Access to Your Health Information Check with your health care providers or doctors to see if they offer online access to your medical records. Terms sometimes used to describe electronic access to these data include personal health record, or PHR, or patient portal.

What hospitals are part of the Kettering Health Network?

Hospitals Hospital nameLocationFormer Name Kettering Health Dayton Dayton Grandview Hospital and Medical Center Kettering Health Greene Memorial Xenia Greene Memorial Hospital Kettering Health Hamilton Hamilton Fort Hamilton Hospital Kettering Health Miamisburg Miamisburg Sycamore Medical Center5 more rows

How do I get MyScripps medical records?

Request records: Log in to MyScripps and look for the Request Medical Record section under the menu and complete the steps within the Sharing Hub. Records requested will be delivered to your MyScripps account and may incur a processing fee.

How do I request records from Kettering medical Center?

Request Medical Records Call (937) 762-1200 to speak to a medical records representative with questions about requesting copies of your records, allowing access to records and more.

The Kettering Health Network (Hospital) authorization form 2025

Here's how it works