Request Medical Records

EFFECTIVE IMMEDIATELY: To reduce the risk of COVID-19 infection, the CHMG Health Information Management (HIM)/medical records department, who processes requests for medical records for all LeBauer Practices, is closed to the public. We are no longer accepting walk-in requests for patient records until further notice. Patients can submit their medical record requests via MyChart, email, mail, fax, or call us for more information on how to request your records.

Address:  Cone Health Medical Group – Health Information Management Dept.; 300 Wendover Ave East; Greensboro, NC  27401
Hours of Operation: Monday- Friday 8am-5pm (closed most major holidays)
Phone number: 336-663-5181 / Fax number:  336-663-5369
Email:  chmghim@conehealth.com

How To Request Your Medical Records

If you have a MyChart account, log in to see if the information you’re seeking is there. You can download, print and send information to health care providers from your MyChart account.  If you don’t have a MyChart account yet, you can request account activation here.  

If you are not on MyChart, or the information you need is not available on MyChart, download and complete one of the following forms. If you are unable to print call 336-663-5181 or email chmghim@conehealth.com to request the form to be mailed to you.

Patient Access Form [PDF] (available also in Spanish)

This form is used when you as the patient, or parent/legal guardian of the patient, want the records for yourself or want the records to be sent to a health care provider outside of Cone Health. 

Please note:  If you want your records sent to another health care facility, first ask what information the facility requires. Most health care facilities do not require or want your entire record.  Ask if the facility is on the EPIC health information management system; if it’s on EPIC, you may not need to complete the request form. 

Patient Access Form Instructions

  • Print or electronically fill in the form, then print and sign. (Electronic signatures are not accepted.)
  • Complete all blanks. Incomplete forms may be returned, thus delaying receipt of your records. If you have any questions about the form, please call 336-663-5181.
  • Complete one form per practice/facility you require records from. Hospital records must be obtained from the hospital.  
  • Add the LeBauer practice name in the blank provided after the check box for “Cone Health Medical Group practice (specify)”. Look up the practice office name.
  • If you are unsure of dates of service covering your care, add a year range such as “Jan. 2010” to “December 2020” or you can add the words from “first visit” to “present”. 
  • Be sure to select the appropriate boxes for the information you need disclosed. 

Cone Health Medical Group Release of Information Form [PDF] (available also in Spanish.)

This form is used when you as the patient, or parent/legal guardian of the patient, want the records to be sent to a third party (defined as someone other than yourself or a health care provider). 

Release of Information Form Instructions

  • Print or electronically fill in the form, then print and sign. (Electronic signatures are not accepted.)
  • All blanks except the MRN blank must be completed. Incomplete forms will be returned, thus delaying receipt of your records. If you have any questions about the form, please call 336-663-5181.
  • Look up the practice office name, address, and phone number. This is needed for the first box on the top of the form. You will use the practice name again in the blank after the phrase “I authorize Cone Health or”.
  • Complete one form per practice/facility you require records from. Hospital records must be obtained from the hospital. 
  • You must include the purpose of your request.
  • If you are unsure of dates of service covering your care, add a year range such as “Jan. 2010” to “December 2020” or you can add the words from “first visit” to “present”. 
  • Be sure to select the appropriate boxes for the information you need disclosed. 

Leave of Absence Forms

CIOX, our release of information service vendor supports the following LeBauer practices for forms completion:   

  • LeBauer Pulmonary Greensboro
  • LeBauer Pulmonary Burlington
  • LeBauer Gastroenterology

For all other LeBauer Practices you must contact your provider’s office for information about forms completion.

CIOX, located at CHMG Health Information Management Department, is accepting patient walk-in requests for the forms (FMLA, Disability, Leave at Absence) by appointment only.

  • Patients must contact CIOX at 336-663-5188 to schedule an appointment
  • Appointments times are available between the hours of 9-11am and 2-4pm.
  • Print, sign and complete the  Cone Health Medical Group Release of Information Form [PDF] (also available in Spanish) to bring to your appointment with the forms you need completed.
  • Patient’s must submit a $25 fee via check, money order, or exact cash upon arrival.
  • It can take up to 7-14 business days to process your forms request.

Medical Records Fees for Patients

To view our fee for medical records, including electronic and paper delivery, click here.

To view our full privacy policy, click here.

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