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Patients & Visitors

Request Medical Records

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.

This document is in PDF format and requires Adobe Acrobat Reader. If you don't have this software, go to Adobe for a free download .

Medical Records Request Form