Ascension Providence Hospital - Novi Campus

Under Federal and State law, a patient has a right to request a copy of his or her medical records. However, a completed written authorization is required prior to processing a request. For your convenience, St. John Providence, part of Ascension, has made available a medical records authorization form that may be downloaded for your personal use. Be sure to specify the dates of service and the type of information needed. If you are requesting records be sent to you, you will receive a bill.

Mail the completed authorization form to:
Ascension Providence Hospital, Novi Campus
Health Information Management Dept.
47601 Grand River Ave
Novi, MI 48374

Questions? Call 248-465-4230.

Medical Records Authorization Form

Under Federal and State law, a patient has a right to request a copy of his or her medical records. However, a completed written authorization is required prior to processing a request. For your convenience, St. John Providence, part of Ascension, has made available a medical records authorization form that may be downloaded for your personal use. Be sure to specify the dates of service and the type of information needed. If you are requesting records be sent to you, you will receive a bill.

Mail the completed authorization form to:
Ascension Providence Hospital, Novi Campus
Health Information Management Dept.
47601 Grand River Ave
Novi, MI 48374

Questions? Call 248-465-4230.

Medical Records Authorization Form