After you have printed this form, complete it and mail it to:
Missouri Baptist Sullivan Hospital
Health Information Management
ATTN: Release of Information
751 Sappington Bridge Road
Sullivan, Missouri 63080 USA
If you have any questions, call between 8 a.m. and 4:30 p.m. Monday through Friday: 573.468.1358.
Please note that a fee may apply.
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Medical Records Request Form