Request for Records

Fire Related Records

To obtain any fire related records, please fill out the form below and return to the Administration Office, 1911 Stewart Ave.*

Request for Record Copy (PDF)

*Fees may apply.

Medical Related Records

Patients

Patients seeking copies of their own medical records may do so by filling out the form below and return to the Administration Office, 1911 Stewart Ave.*

Request for Record Copy (PDF)

*Fees may apply.

Other Agencies or Family Members

Other agencies or family members must obtain patient’s written permission or hold a “Power of Attorney” to obtain any medical records. To request these records, please contact:

Dawn Hiebert
Medical Claims Specialist
(785) 830-7040 FAX (785) 830-7090
dhiebert@lawrenceks.org

HIPAA – Notice of Privacy Practice