Confidentiality
Your medical record will be treated as confidential by all medical and office staff. No one may obtain a copy of your medical record without written consent with the exception of those required by law, continuation of care or third party payor/insurance contract.

How to submit requests and receive record copies
To request a copy of your medical records, download, print and complete the Authorization to Disclose Health Information Form. Mail or fax your request to Grand Rapids Home for Veterans, Medical Records, 3000 Monroe Avenue NE, Grand Rapids, MI 49505; fax number 616-364-5341.

Requests will be processed within 10 days of receipt; however some requests may require additional time to process.

Records can be released to anyone that the member authorizes in writing to receive such information. A valid authorization must contain the following information or the request will be returned. A new authorization is required each time a request is made.

• Member's full name and date of birth
• Specific information being requested/date of service
• Purpose for which the information may be disclosed
• To whom the information is to be sent
• Signature of member or member legal representative
• Date of the signature

Fees
There may be a fee for copies of your medical record. Please contact the Medical Records Department for current fee information.

Sharon Gregory
Privacy Officer
Medical Record/Transcription Supervisor
616-364-5287
GregoryS9@michigan.gov

Alternate Contact Persons include:

Marjorie Gates - Medical Records
616-364-5360
GatesM@michigan.gov

Rhonda Gould - Transcription/Medical Records
616-364-5281
GouldR9@michigan.gov