Release of Medical Records and Medical Billing Records
Procedure and Information
Applicant may request authority to obtain the decedent’s medical records and billing records for the purpose of
evaluating a potential wrongful death, personal injury, or survival action on behalf of the decedent.
See R.C. 2113.032.
Initial Deposit ( Cash / Check / Money Order Only) $80.00
-Photocopy of the death certificate – Social Security number redacted (must state Lake County resident)
-Application to Release Medical Records and Medical Billing Records (Form 29.0)
-Surviving Spouse, Children, Next Of Kin, Legatees And Devisees (Form 1.0)
-Waiver and Consent- Release of Medical Records and Medical Billing Records (Form 29.4)
-Notice of Application to Release Medical Records and Medical Billing Records (Form 29.3)
All forms can be mailed to:
Lake County Probate Court
P.O. Box 490
Painesville, Ohio 44077