Release of Medical Records

Pawnee Valley Campus is happy to provide you with a copy of your medical record for follow-up care, insurance purposes or your own use.

To request a copy of your medical records, mail or bring a completed Authorization Form to:

Medical Records Department
The University of Kansas Health System
Pawnee Valley Campus
923 Carroll Ave.
Larned, KS 67550

Charges

Continuing Care – no charge if the records are sent directly to another care provider. Please enter the care provider’s name and address on the authorization form in Section 3.

Personal Use – Pages 1-10 are 50 cents per page, Pages 11+ are 25 cents per page.

Fee for electronic duplication (CD or email, etc.) of records – flat rate of $14.85

This new rate is effective 11/11/2017

Click the button below for the authorization form:
Release of Information

Please allow a minimum of 2 business days for requests to be processed.