If you'd like us to release your personal medical records, read through the Instructions for Authorization Form, then print and complete the Information Request—Patient Authorization.
- Instructions for Authorization Form (PDF)
- Information Request—Patient Authorization (PDF)
- Solicitud de Información – Autorización de Paciente (PDF)
Completed forms can be emailed to firstname.lastname@example.org
Or mailed to:
Saint Luke's Health System
Attn: Release of Information Department
4401 Wornall Road
Kansas City, MO 64111
Proxy access is when a family member or caregiver can view a patient’s protected health information (PHI) through the mySaintLuke’s Patient Portal. The access must be authorized by the patient, and multiple parties may be given access.
Adults & Children
If the patient has a mySaintLuke’s account they can fill out the authorization form for adult-to-adult (patient is age 18+) and adult-to-child (patient is age 0–11) in the Patient Portal or can complete the request form:
- Adult-to-Adult Proxy Request Form (PDF)
- Adult-to-Child Proxy Request Form (PDF)
- Formulario de solicitud de proxy de adulto a adulto (PDF)
- Formulario de solicitud de proxy de adulto a niño (PDF)
Completed forms can be emailed to email@example.com or dropped of in a Saint Luke’s clinic.
Requests for adult-to-teen (patient is age 12–17) access need to be completed in a Saint Luke’s clinic or through Saint Luke’s Health Information Management by calling 816-880-6036 or emailing firstname.lastname@example.org.