Ohio Rev. Code § 2317.022
"WRITTEN STATEMENT REQUESTING THE RELEASE OF RECORDS
To: ____________________ (insert name of the health care provider in question).
I hereby state that an official criminal investigation has begun regarding, or a criminal action or proceeding has been commenced against, ____________________ (insert the name of the person in question), and that I believe that one or more tests has been administered to that person by this health care provider to determine the presence or concentration of alcohol, a drug of abuse, a combination of them, a controlled substance, or a metabolite of a controlled substance in that person's whole blood, blood serum or plasma, breath, or urine at a time relevant to the criminal offense in question. Therefore, I hereby request that, pursuant to division (B)(2) of section 2317.02 of the Revised Code, this health care provider supply me with copies of any records the provider possesses that pertain to any test or the results of any test administered to the person specified above to determine the presence or concentration of alcohol, a drug of abuse, a combination of them, a controlled substance, or a metabolite of a controlled substance in that person's whole blood, blood serum or plasma, breath, or urine at any time relevant to the criminal offense in question.
_____________________________________
(Name of officer)
_____________________________________
(Officer's title)
_____________________________________
(Officer's employing agency)
_____________________________________
(Officer's telephone number)
_____________________________________
_____________________________________
_____________________________________
(Agency's address)
_____________________________________
(Date written statement submitted)"
R.C. §2317.022