Obtain Copies of Medical Records

The results of all tests and medical treatment that you received during your hospital visit are documented and maintained in a medical record file(s). Also included are physician reports from examinations, surgery reports, treatment and medications, and observations by nurses and other members of your healthcare team. This information is combined to make up your medical record.

How to Obtain Copies of Medical Records

Requests for medical records may be made by returning an Authorization for Disclosure of Health Information form via mail or FAX.
Records can be released to anyone that the patient authorized (in writing) to receive such information. A valid authorization must contain the following information, or the request will be returned.

• Patient’s full name and date of birth
• Specific information being requested (e.g., type of report/information and dates of service, etc.)
• Purpose for which the information may be disclosed
• To whom the information should be sent (name and address)
• Authorization expiration date
• The patient’s signature or a patient’s legal representative’s signature. Authorizations signed by a representative must contain a copy of the guardianship papers or power of attorney
• Date of signature

In most cases, the Authorization for Disclosure of Health Information form for patients under the age of 18 must be completed by a parent or legal guardian.

Sensitive Information
Certain information requires a special authorization covering sensitive information. This may include psychiatric, drug and/or alcohol abuse, HIV/AIDS, and sexual abuse information. Authorizations for sensitive information must specifically refer to the information that is to be released.

Deceased Patients
Requests for medical records of deceased patients require a letter of authority in addition to your signed request. The letter of authority is given to the executor or administrator of a person’s estate by the Probate Court upon his/her death. Releasing records to anyone other than the executor or administrator is not permitted by law. Please include your phone number in the event we need to contact you for additional information concerning your request.

2012 Related Reproduction Fees

1 to 20 pages	$1.39 per page
21 to 60 pages	$1.03 per page
61 and over pages	$0.34 per page
Amount charged per page for microfilm copies	$2.04 per page
Postage fees will also be added if records are mailed.
Flat fee for production of records to support any claim under Social Security	$26.12
Fee for reproducing diagnostic images:
First request	Free of charge
Second request	$25.00 plus $1.00 per page of images
Flat fee for supplying records requested by a district attorney	$20.62
Search and retrieval of records costs not to exceed	$20.62

Note: rates are subject to change annually at the discretion of the Secretary of Health.