Medical Record Requests

If you had a HealthSpan Physician, a doctor who practiced for the once exclusive physician group for the HealthSpan health plan, and need to transfer your medical record, we’re here to help. Please complete this form for authorization to use and/or disclose protected health information and either mail, email or fax the form to Mercy Health:

Attn: Health Information Services
3700 Kolbe Road
Lorain, Ohio 44053

Fax (440) 960-4635

Phone: (440) 960-3320