Requesting Your Medical Records
Note: Beginning October 30, the Health Information Management department (Medical Records) will be restricting in-person medical record requests due to the current Coronavirus (COVID-19) precautions being put in place across our system.
There are a few ways you can request copies of your medical records, depending on the type of information you need. You can access portions of your electronic medical record online through the Patient Portal or through the Medical Records office.
How to Request Your Medical Record
Complete the correct form and mail, fax or drop off at the corresponding Beacon site listed below. You may also email forms to gro.metsyshtlaehnocaeb@noitamrofnifoesaeler. Please include a copy of your photo identification along with your request or submit the request in person.
- Patient Directed Request for Protected Health Information (PDF) | Información en español
(Use this form for your own record or if you are the legal representative of another person)
- Authorization for the Use and Disclosure of Protected Health Information (PDF) | Información en español
(For 3rd Party requestors)
- Health Information Exchanges Revocation of Opt-Out Request Form | Información en español
Questions about our forms? Read our FAQ