The Amelia T. Wood Student Health Center at Ball State University is administered by Cardinal Health Partners.  We follow the policies and procedures established by that health system for the protection of medical information.  Those policies and procedures, in turn, are established to meet the requirements of the Federal Health Information Portability and Accountability Act.  In order to request your records, you must first download the Authorization for release of medical records form.  You must have Adobe Reader to open this file.  If you do not have it you may download it at www.adobe.com by clicking the icon on the left side of the page which says "Get Adobe Reader."

In order to obtain medical records, follow these directions:

1. Print the consent form and fill it out completely.
   
   • Must provide at least your first and last name, middle initial and date of birth.
   • Include your phone number and a billing address in case we need to contact you about your request.
     

2. Mark the information you want in the box in the upper right hand cornor. 
   • If you don't see a description which matches what you want, write in a description of the information you want. 
     

3. In the center of the form, fill in any specific limitation on the release.
   • For instance, if you want only information related to an automobile accident, write it in here.
   • If there are no limitations, write "none." 
     

4. At the line labeled "This information is to be disclosed to:" list the complete address for where to send records and telephone number.
   • If you wish the records to be sent to you, write your own name and address here.
   • We can fax records only if they are needed for patient care, otherwise they must be sent via mail.  For instance, if you are in a doctor's office or hospital receiving care, and your medical information is needed to facilitate your care, we can fax them.
     

5. Fill in the purpose for the release.
   • "Continuing medical" or "For personal records" will be accepted.
     

6. Sign (written signature) and date the form to validate.

Please submit request to:

Ball State Student Health Center
1500 Neely
Muncie, IN 47306
Fax: (765)285-1103

We are typically able to fulfill requests within 10 business days.