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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


Forms
Checklist and Packet- Application to Release Medical Records and Medical Billing Records
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)
Report on Receipt of Medical Records and Medical Billing Records (Form 29.2)