SUMMIT COUNTY COURT OF COMMON PLEAS - PROBATE DIVISION
JUDGE ELINORE MARSH STORMER

Instructions for Filing Release Of Decedent’s Medical Records

What I Need When Filing:

  • The Filing Fee Is $100.00 (Without The Will)
  • The Filing Fee Is $130.00 (With A Will)
  • Type or Clearly print all form information
  • A Copy of the Death Certificate

These forms must be filed (If there is an Original Will):

  • Form 2.0 – Application To Probate Will
  • Form 2.1 – Waiver Of Notice Of Probate Of Will
  • Form 2.4 – Certificate Of Service Of Notice Of Probate Of Will
  • Form 1.0 – Surviving Spouse, Next Of Kin
  • Form ES.28.0 – Application To Release Decedent’s Medical Records
  • Form ES.28.1 – Notice Of Application (If No Consents Obtained)
  • Form ES.28.2 – Waiver Of Notice And Consent
  • Form ES.28.3 – Order Authorizing Release
  • Form ES.28.4 – Report Of Receipt Of Medical Records (Once Obtained)
  • Form Misc.02 – Self-Representation Acknowledgment

These forms must be filed (If there is NO original Will):

  • Form 1.0 – Surviving Spouse, Next Of Kin
  • Form ES.28.0 – Application To Release Decedent’s Medical Records
  • Form ES.28.1 – Notice Of Application (If No Consents Obtained)
  • Form ES.28.2 – Waiver Of Notice And Consent
  • Form ES.28.3 – Order Authorizing Release
  • Form ES.28.4 – Report Of Receipt Of Medical Records (Once Obtained)
  • Form Misc.02 – Self-Representation Acknowledgment