You have the right to request to amend health information we maintain about you or your child if you believe the health information is inaccurate or incomplete. Please note, this does not include routine changes such as change of address or phone number.
All of the following form fields below must be completed. If left blank, this could lead to delay in the processing of your request. If the patient is a minor, the legally authorized representative must complete this form. If the patient is an adult, they must complete the form themselves.
No later than 60 days after you submit this completed form, you will receive a written response to your request via mail from Nationwide Children’s Hospital.