Medical Records Information
To obtain a copy of medial records from Public Health – Dayton & Montgomery County please follow the instructions below.
Public Health can provide vaccination records for individuals who were vaccinated by Public Health, or in some cases, who received a vaccination in the State of Ohio from a vaccine provider such as a doctor’s office or pharmacy.
Please note that providers are not required to report vaccination records to the State of Ohio database, in which case, your record may not be available. In addition, State of Ohio records do not include vaccinations that were provided in other states or through a federal agency such as a branch of the US Armed Forces.
How to Submit Your Request
Please complete an Authorization for Release of Health Information Form(298 KB) and choose an option below. (The form must include a valid phone number so that we may follow up with you if we have questions about your request).
- Complete an Authorization for Release of Health Information Form(298 KB)
and email it to:
This email address is being protected from spambots. You need JavaScript enabled to view it. - Fax a completed form to: (937)496-6982
- Mail a completed form to:
Public Health – Dayton & Montgomery County
Medical Records Department
117 South Main Street
Dayton, OH 45422-1280 - ·Drop off a completed form in person at the Public Health Clinic registration window located on the 3rd floor of the Reibold Building.
(Please note you may drop off the form in person at the Clinic; however, same day service for records pickup is not available.)
You must include a copy of all necessary supporting documentation with your request; otherwise, it cannot be processed.
List of acceptable government-issued photo IDs:
- Driver’s License
- State ID
- US Passport / US Passport Card
- Interim ID
- US Military or National Guard ID
- US Department of Veterans Affairs ID
Supporting Documentation
For yourself
- A copy of your valid, government-issued photo ID.
For a minor
- A copy of your valid, government-issued photo ID.
- A copy of the birth certificate for the minor or your most recent tax return showing the minor as a dependent as proof of parental relationship. Birth Certificate records may be obtained through Vital Statistics.
- If not a parent, include court-issued documents: custody orders, guardianship papers, or Power of Attorney for Healthcare.
For a Deceased Person
- A copy of your valid, government-issued photo ID.
- Proof of death (a death certificate or obituary). Death Certificate records may be obtained through Vital Statistics.
- Documents proving your legal right to the records, such as Letters Testamentary if you're an executor, or birth/marriage certificates to show relationship as next-of-kin for medical records.
Tracking/Status Updates
- There is no charge for patients to receive copies of their medical records.
- Please allow a minimum of 7 business days for your request to be processed. Same-day requests are not accepted.
- Once your records have been located, you will receive them by the delivery method you selected.
- If you wish to pick them up in person, you will be called when your records are ready. Please come to the registration window in the Public Health Clinic with proof of identity.
- If you do not hear from us after 10 business days, you may call (937)-225-4189 to check the status of your request.
Privacy Notice
The form and documentation will be handled in accordance with HIPAA/privacy laws, and you should ensure your ID and signature are accurate. Public Health cannot release records without the proper authorization and supporting documents.
Not All Records are Available
- If Public Health did not administer all the vaccines you have received, your record may not be complete.
- The Ohio Department of Health maintains a database othat allows providers to record immunizations/vaccinations administered in the state of Ohio.
- You can directly contact the State of Ohio to see if they may have your record.
- COVID-19 vaccine providers in Ohio are required to report patient information into the State of Ohio Vaccination Database when the COVID-19 vaccine is administered. If you have received the COVID-19 vaccine in Ohio, your information should be in the system.
- Please note that medical providers in Ohio are not required to report other immunizations to the state system. It is possible that other vaccinations will not be recorded in the State of Ohio Vaccination Database.
- State of Ohio records do not include vaccinations that were provided in other states or through a federal agency such as a branch of the US Armed Forces.
- There is no single national database for medical records.
- If you need medical records from other providers, you will need to contact previous healthcare providers, schools, employers, or your state health department's immunization registry.
- If you have previously provided Public Health with your vaccination records, those records will be included in the designated record set and released to you upon request.
If you have any questions, please call (937)-225-4189
To Revoke your Authorization for Releasing Information
- Complete our Revocation of Consent to Use Disclose Health Information(192 KB) and provide your valid government issued photo ID. No other supporting documentation is required. The form must include a valid phone number. It allows us to follow up with you if we have questions about your request.
