Health Records


To transfer your records, complete the appropriate form below.
You can do this online or by downloading and filling in the form by hand.

If you are currently a patient wishing to transfer healthcare services to CHC/SEK, it is necessary to get your approval for the transfer of your records to CHC/SEK. Parents and guardians may complete a release of medical records for patients who are under 18 years old.

Mercy Clinic Patients


Fort Scott, Arma and Pleasanton

Complete the online version
English
Spanish
Download the forms and complete by hand
English
Spanish

Mound City Family Care Patients



Complete the online version at (Link is coming soon)

 

Download the forms and complete by hand
English
Spanish

Submit Forms

Downloaded forms can be returned to clinic staff, faxed to 620-235-0869, or mailed to:
CHC/SEK
P.O. Box 1832
Pittsburg, KS 66762