Patients and their authorized representatives are able to request personal copies of medical records upon the submission of a written request to OBH. If records need to go directly over to another provider, school, employer, disability company, or any other entity this is not the correct method for making such a request (please use our Release of Information form for such requests, see the Downloads section below). To accommodate our patients we are able to initiate record requests by two different methods, either through a letter of request or through the use of our specialized request form.

Letter of Request

We will accept a letter of request from a patient (or their authorized representative). We require the following items to be present in the letter to be considered valid:

  1. Patient Name
  2. Patient Date of Birth
  3. Name of Authorized Representative (if not initiated by the patient)
  4. Date of Request
  5. What is being requested (e.g. what chart documents are needed)
  6. Reason for Request
  7. Patient or Authorized Representative Signature
  8. Signature Date
  9. Legal justification and/or supporting documentation if the patient is not request directly

Patient Request for Health Information Form

Please check the download section below for the Patient Request for Health Information form. This form is a basic PDF that can be used to submit a request for records. This form should only be used by the patient or their authorized representative. All elements on the form should be completed, and if not applicable please indicate this with a N/A or similar indicator.

Where to Submit

Requests for medical records should be faxed to (614) 591-4480 (secure fax) or via mail to:

Optima Behavioral Health

Attn Medical Records

81 Outerbelt Street

Columbus, Ohio 43213

Turnaround Time & Copy Fees

We do our best to return records in a timely manner. In most cases we are able to furnish records within a week or two of receiving a valid request, requests may take longer depending on the scope of the request and if we need to locate a paper record. If a request is going to take longer than 30 days to complete we will provide a written notice regarding the delay. The timeline for record request turnaround starts upon the receipt of a valid request.

If no records are found we will notify the requester in writing, and additionally by telephone if this is noted as the preferred method of contact.

Requests for records may incur a copy fee based on the Ohio Revised Code (which is a tiered fee schedule that is determined by the total number of pages in the request) and labor involved in completing the request. The Ohio Department of Health maintains the pricing index for all medical record copy fees, which is updated annually. Electronic copies or copies of records that are stored electronically have a reduced copy fee. We will do our best to provide an estimate for copy fees up front, or a more specific quote if requested before completing the record request.

Emailing Records

The security of email is often inadequate for the transmission of medical records and our email communications with patients are not encrypted, but we will comply with email use if specifically requested. In order to use email for communicating medical records OBH requires the use of an additional disclosure form (see the Emailed Informed Consent form in the Downloads section).


Patient Request for Health Information (pdf)


Release of Information (pdf)


Email Informed Consent (pdf)