Medical record release authorization – Indiana
Use this downloadable form or secure online form to request your medical records from American Health Network (AHN) or to ask AHN to send your records to another facility.
- Use our secure online form to ask for a copy of your medical records, or
- Download the form
- Find your health care provider's address and phone number on this website. Call the phone number to get the correct fax number.
- If your provider is no longer with American Health Network, please complete the form and mail it to:
Optum & American Health Network
Attention: Medical Records Department
13000 N Meridian St., Ste. 250
Carmel, IN 46032