Ascension Providence Hospital, Southfield Campus

  • Emergency Care
  • Primary Care/Clinic
  • Hospital/Medical Center
  • Imaging
  • Laboratory
Hours Visiting Hours: 11 a.m. to 8 p.m.

Medical Records Request

As a patient, you have the right to access your medical records. Here you'll find instructions and a convenient form to help us process your request.

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:
Providence-Providence Park Hospital, Southfield
Health Information Management Department
16001 West Nine Mile Rd.
Southfield, MI 48075

Questions? Call 248-849-5580.

Medical Records Authorization Form