Authorization to Release Health Information
For Patients
- Planning your Visit
- Arrival
- Billing
- Care Team
- Dining
- Hotels & Transportation
- Patient Rooms
- Parking
- Registration
- Authorization to Release Health Information
- Retail Services
- Pharmacy
- Visitors
- Returning Home
- Classes & Programs
Expand/Collapse
- Events Calendar
- MyChart
Expand/Collapse
An Authorization to Release Health Information form needs to be completed in order to file claims for FMLA and Disability, or to obtain copies of medical records and X-rays.
Download the Authorization to Release Health Information.
Please submit the completed form and, if applicable, any FMLA or Disability paperwork, Medical Records, or X-rays to:
By Mail
Indiana University Health Arnett
Health Information Management
PO Box 5545
Lafayette, IN 47903
In Person
IU Health Arnett Medical Offices
2600 Greenbush Street, 2nd Floor
Lafayette, IN 47904
By Fax
FMLA/Disability: 765.448.8540
Medical Records: 765.448.8722
X-rays: 765.448.8621
Authorization to Release forms can also be dropped off at any IU Health Arnett Medical Office for submission to the appropriate department.
Please contact Health Information Management at 765.448.8206 for additional assistance.