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Release of Information Form

If you would like to request your Health Information be sent to an outside providers' clinic/hospital or need copies of your Health Information, please use the link below to access the Release of Information Form, there may be a cost associated with this, please contact the Health Information Staff if you have any concerns or questions.
Release of Information Form-Ruby Memorial Patients
Chestnut Ridge Hospital Release of Information Form-Ruby Memorial Patients
Release of Information Form-United Hopsital Center Patients
Release of Information Form-St. Josephs Hospital Patients
Understanding the Release of Information Process
To request a release of records from providers outside of the WVU Health System to your WVU provider, use the link below:

Release for Outside Records (to be used externally)