Contact Medical Records

Please use the secure form below to send a message to the Medical Records Department. A Medical Records Coordinator will contact you via phone within 1-business day to address your request. Please note that all responses from the MHNI Medical Records Department will be made via phone as email is not a secure platform to transmit health privacy information. Fields marked with an * are required.

Contact Information

First Name: *

Last Name: *

Date of Birth *

Month

Day

Year

Home Phone: *

Work Phone:

Cell Phone:

Preferred Daytime Contact Number: *

Preferred Time of Day to Contact: *

Email Address: *

Issue/Concern/Message for MHNI Medical Records:

The message area below should not be used by individuals who have a clinical circumstance under question which needs direct involvement of a medical professional. Individuals who need direct involvement of a medical professional should contact him/her directly. Please use this area solely to provide information that is intended for the MHNI Medical Records Department.

**IMPORTANT** Please note that you must have a current Authorization for Disclosure of Patient Health Information on file before MHNI will release any records or communication to an outside party.

Please download and complete an Authorization for Disclosure

Mail to:
MHNI
Attn: Medical Records Department
3120 Professional Drive
Ann Arbor, MI 48104

FAX to:
(206) 666-1851

Or upload completed form:

Request Type

Nature of Request *

Send medical records to outside party

Request insurance/medication coverage appeal letter

Request dictation from MHNI provider

Request work/school letter

Other (please briefly specify)

Nature of Request Other (please briefly specify)

Address Request To:

(Only complete applicable fields)

Name of person and/or organization:

Attention:

Street Address:

City:

State/Province:

Zip/Postal:

Country:

Phone:

Fax:

Contract #:

Group #:

Claim/Case/Appeal #:

Please copy me on requested appeal/dictation/letter

Medical Records Request:

Please use this area solely to provide information that is intended for the MHNI Medical Records Department. Include details necessary to process your request such as the medication or service you are appealing coverage of, applicable claim or case numbers, MHNI care provider, rationale for school/work request, etc. The message area below should not be used by individuals who have a clinical circumstance under question which needs direct involvement of a medical professional. Individuals who need direct involvement of a medical professional should contact him/her directly.

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Patients & Visitors

Healthcare Providers

2024 MHNI Holiday Schedule

MHNI will be closed on the following days:

Dr. Weintraub retired effective May 12, 2022.

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Contact Medical Records

Patients & Visitors

Healthcare Providers

MHNI will be closed on the following days: