Requesting a Copy of Your Health Records
To obtain a copy of your medical, dental, behavioral health, or optometry records, you must complete an Authorization to Disclose Protected Health Information form. This form can be accessed by clicking here, visiting the clinic where you typically receive care, or by calling our Health Information Department at 270-858-6655 (Option 5).
Once completed, you may submit your request in by email to
, by fax to 844-475-2310, by mail to PO Box 2399, Russell Springs, KY 42642, or in person.
A valid photo ID is required when requesting and picking up records. Only the patient or a legally authorized representative, such as a parent or legal guardian, is permitted to request or collect records. This form must be completed before any health information can be released.
Requests are processed in the order they are received and will be completed within 30 days of receiving a signed authorization. For expedited requests, please call the Health Information Department directly to make arrangements.
Under Kentucky law, patients are entitled to receive one free copy of their medical records, whether for personal use or to share with a third party. Additional copies may incur a reasonable fee, which must be paid prior to release. To avoid future costs, we recommend keeping a personal copy of any records you request.
For further assistance, please contact the Health Information Department at 270-858-6655 (Option 5).
HIPAA Compliance
Cumberland Family Medical Center, Inc. (CFMC) recognizes that all patient information is confidential and personal and is committed to protecting your privacy in relation to your health records. Our Notice of Privacy document details for you our specific privacy practices as well as the ways in which your medical information may be disclosed.
All CFMC patients have the right to receive a copy of the complete Notice of Privacy document. Please click here to download a copy. For more information or if you have a question regarding this issue, please call our Administrative Offices at 270-858-6655.