Medical Record Release Forms

Medical Release Forms

Valley Health Systems keeps a private, secure medical record about your health, and you can request a copy of your medical records at any time in one of the following ways:

**As a note, all of our facilities are located in south/southwestern WV, with one location in Coal Grove, OH. We are not affiliated with any other Valley Health organization in New Jersey, Virginia, or any states other than West Virginia or Ohio at this time. Please double check that you have the correct location before submitting your request for records.**

1) By submitting your request through our online request tool:

This is a secure and user-friendly way for patients to request records by using their computer, tablet, or smartphone. It takes approximately 5 to 10 minutes to complete.

Note – All requesters will need to submit a form of identification through this online tool for identity verification purposes.

If you are the patient, you will need to submit a photo of your driver’s license or other government photo ID.

If you are not the patient, you will need to submit a form of legal documentation verifying that you’re authorized to make a request for the patient’s records. Examples include the following: Medical Power of Attorney, Custody or Guardianship papers, Court Orders, Executor or Administrator of Estate documents. You will also need to submit a photo of your driver’s license or other government photo ID for identity verification along with the documentation outlined above. **Authorized parents who are listed on their child’s medical record do not have to upload supporting documentation and may skip this step. Photo ID is still required to verify identity.


If you are a medical provider or facility, and would like to request faxed or mailed copies of records on a patient for continuity of care, the tool below is available to you to submit a paperless request. Email verification is required for security purposes.

2) You can print or download a copy of our Valley Health authorization here:

General Request for Records – ROI – General_updated 1.2024

Behavioral Health/Therapy – ROI – Psychotherapy_updated 1.2024

You can submit this form to us in one of the following ways:

Mail to: Valley Health Systems Business Office

Attn: Medical Records

5636 US Rt. 60, Suite 1B

Huntington, WV 25705

Fax to: 304-399-3236

You can also drop off your authorization form at any Valley Health location.

3) If you do not have access to a computer or smartphone, we can mail you a copy of our Valley Health release form(s) upon request, please contact us at 304-399-3394. You can also request these forms in person at any Valley Health Systems location.

We use Datavant (formerly known as Ciox Health) as our vendor to process medical records requests. Datavant offers secure methods of records delivery, and partnering with Datavant for the records request process has allowed for faster turnaround times to improve patient satisfaction.

To check the status of a request you have submitted to us:
Please contact Datavant’s Customer Service line at 800-367-1500 for status checks. Datavant will handle any invoice related questions.

You can also contact the Valley Health Medical Records Department at 304-399-3394 for any questions you may have about the status of a request or the medical records process.

Please Note: Most requests will be completed within 3-5 business days, but please allow up to 30 days by law for your request to be processed. Requests for large or older timeframes may include a large volume of records and/or records that need to be retrieved from our off-site storage facilities, and can take longer to process.

If you already have a request you need to submit, our contact information is listed below:

Valley Health Systems Business Office

Attn: Medical Records

5636 US Rt. 60, Suite 1B

Huntington, WV 25705

PHONE – 304-399-3394

FAX – 304-399-3236

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