Medical Records Request






CHI Memorial Medical Records office hours are Monday - Friday, 8:00 a. When Will You Get the Requested Medical Records? HIPAA requires medical providers to provide copies of medical records within 30 days of your request. The form should also be used if you wish to share records with someone for whom you have legal authority (parent of minor, etc. To request copies of your medical records after discharge, ask to speak to Medical Records Correspondence section at your hospital. Medical Records Request. The department is located on the corner of Carpenter and 9th streets. Urgent Requests, Records for your Physician. Requests for Medical Records. You can request that a PDF be released to you within MyChart or a physical copy sent to another medical office. Copies are provided only after the patient is discharged. Request copies of medical records from outside agencies or other VA Medical Centers. To Request a Copy of Your Medical Records: 1) Complete the attached form “Authorization to Use and Disclose Protected Health Information. For example, a. To place your order, call 847-618-3200 and press option 2. Request Medical Records; Request Medical Records You may request medical records by completing the Authorization for Release below and submitting as directed. How to Request Medical Records from Roswell Park Click to download the Authorization to Release Medical Information from Roswell Park Download and print form, fill in information return to us via mail or fax: Roswell Park Comprehensive Cancer Center c/o Health Information Management Carlton Building Rm 107 Buffalo, NY 14263 FAX: 716-845-8394. You may mail a written request to the address below, which should contain as much information as possible to assist us in identifying your record(s). Requesting Medical Records New Brunswick Campus. Electronic health records allow your doctors to immediately review and update your health records at any of the Allina Health hospitals and clinics you visit. Bernard Hospital, 326 West 64th Street, Chicago, IL, 60621, and you will be directed to the office. Execution of an affidavit or certification of a document, not to exceed the charge authorized by Civil Practice and Remedies Code, §22. Keep reading to learn more and download forms. To request a hard copy of your medical records, complete a Medical Records Request Form and fax it to 920-262-4266, or drop your completed form off at Watertown Regional Medical Center. CHI Memorial Medical Records office hours are Monday - Friday, 8:00 a. Additionally, we are pleased to announce that you may view your records through a secure portal known as MyChart. You can request a copy of your Mount Sinai health records from any hospitalization, surgery, clinic and emergency room visits from our Health Information Management/Medical Records departments. To order the medical or billing records of others (third-party requests) First, please read these instructions. Medical Records. To request a copy of your medical record(s), you must complete an Authorization to Request Medical Records. To start your request, simply download and complete the appropriate authorization form. To request a copy for Ascension Medical Group locations, complete the medical record release form. Request Medical Records Patients who have received care at a Tennova Healthcare hospital may request copies of their medical record/health information by contacting the hospital where you recieved care. In some instances records can be obtained at the same time the request is made. You must sign the form by hand. There is a three-step process for requesting copies of your medical records from IU Health. To correct errors in your medical record, complete the amendment request form. Maximum Time Permitted Under State Law for Doctors and Hospitals to Respond to Patient Requests for Medical Records. Request Medical Records Use Online Tools For copies of your ColumbiaDoctors medical records, a valid Authorization to Release Medical Information form needs to be completed. Request Records from IACH. All requests for medical information from Lawrence General Hospital are directed to the Health Information Services Department. Request a copy of your medical records by logging into MyChart. You may access our online request form. This includes medical records sent to other hospitals, specialists, etc. Costs & Charges. LOUIS, MO DD Form 877-1 is the only request form which NPRC will accept from military facilities for retired medical treatment records. Monday thru Friday. However, there is no charge to have records sent directly to another health care facility or physician for continuation of care. Medical Records Henry Ford Health System is dedicated to collecting, maintaining and providing quality patient health information. Any records can be sent to another hospital, facility or doctor's office for continuing care without a release being signed. When your law practice involves working with clients who are injured in the workplace or injured due to medical negligence, medical product defect, slips, and falls or car accidents, you will have to request, obtain, and review medical records. The health information management department hours are 8:30 a. Medical records are maintained in the Health Information Services departments at Arch Health. Requests for copies of a patient’s record for legal reasons must be accompanied by a patient’s signed Authorization for Release of Health Record Information form or a valid subpoena accompanied by the Authorization for Release of Health Record Information form with Section C completed by the attorney requesting the medical records or a court order authorization for Loyola to release the medical records. The following individuals may sign the authorization for release of medical information: The student/patient; An individual with authorized power of attorney if the student/patient is not able to sign (documentation must be provided). We also assist providers with completing forms for patients. To request information from your medical record regarding your care at ProMedica, download and complete our ProMedica Authorization Form so we can release your medical records to you or send them to another party. Medical Records Salt Lake Regional Medical Center maintains medical records for each patient treated at the hospital. Forms are also available in the Medical Records office. no response to the request for medical records, medical records at the time they receive treatment. The patient, parent or legal guardian must sign a Release of Information form that authorizes Baylor Scott & White Medical Center – Sunnyvale to release copies of his/her records to whom he/she has authorized. No, once your request is received at one facility, as a courtesy we will forward it to the other Emory facility(s) in which you are requesting records. Forms and instructions for requesting medical records are available in the next. The Release of Health Information brochure (PDF) provides patients with information on release requirements and how to request release of their health records to common third parties for various reasons. The easiest way to access your medical records is via MyChart which is available online and as a mobile app. Information in your health record may be printed for you to take to a clinic or hospital that is not a part of Allina Health. If you need more information than you can find on eCare, you can easily request copies of your UW Medicine medical records and radiology images. Also be sure to know your medical records privacy rights. When requesting records on behalf of a patient, please include a copy of your power of attorney. There will be a charge for copies of medical records requested for personal use. Your medical records are kept safe and confidential. If you select to have your medical records mailed to your home or to another location, a copy of your photo ID must be included with the mailed or faxed request. , Suite 112. Request Medical Records Patients who have received care at a Tennova Healthcare hospital may request copies of their medical record/health information by contacting the hospital where you recieved care. Request a copy of your medical records. For medical records from outpatient care or from one of our off-site facilities, contact the facility where you received care. You can request a copy of your medical records at any time, or register for one of our patient portals for direct access to your records. Due to new government policies and strict revised Federal regulations, patients are no longer authorized to hand carry their medical records, regardless of status or PCS location. If we're not able to make records available at the time of request, we will inform you of the status of your medical records and produce your medical record within 21 days from the receipt of the request. If you have any further questions about your medical records, or any general questions about ECMC, complete and submit the contact form below and someone will respond in a timely fashion. Specify dates of service for which records are requested. Patients who have received care at Merit Health Natchez may request copies of their medical record/health information by contacting the hospital and requesting an “Authorization for Release, Use and Disclosure of Health Records” form. If you are coming in person to request records, please make sure you have one of the following forms of ID: driver's license, passport, DMV ID card, military ID card, or federal or state government issued ID. A patient must request, in writing, a copy of medical records. Submit form by: Mail: MLHC - Medical Records, PO Box 40628 Memphis, TN 38174. Sanford Health Release of Information is dedicated to preserving the privacy and security of your health information while ensuring its availability for continuing care, payment, personal needs or other uses. , in Northern and Southern California and Hawaii • Kaiser Foundation Health Plan of Colorado • Kaiser Foundation Health Plan of Georgia, Inc. By law, copies of records may take up to 30 days to receive, please call as soon as possible if you need your records for an out-of-town appointment. Request Records An authorization form is required when you are requesting copies of medical records or asking that we disclose your health information to 3rd parties. When you come to pick up your medical records, please bring photo ID. Filing a Claim for Medical Benefits? The Official Military Personnel Files (OMPF), held at the National Personnel Records Center (NPRC), are administrative records containing information about the subject's military service history. We strive to process all medical records requests within five to seven business days, but according to the Health Information Portability & Accountability Act (HIPAA), Regional West is allowed 30 days to complete a request. To request a copy of your clinic medical records, complete an Authorization for Release of Patient Heath Information form, and submit it to the Health Information Management Department at the clinic. Medical Records Request Authorization for Release of Medical Records revised. To request a copy of your medical record, please print and complete the Release of Information Authorization Form and mail it to the address below along with a photo copy of a picture I. Texas Children’s may verify your identity/guardianship. Washington University partners with CIOX Health, the nation’s largest provider of release of medical information services, to process and fulfill your request for a copy of your medical record. Request Medical Records; Request Medical Records You may request medical records by completing the Authorization for Release below and submitting as directed. Request Archived Medical Records Military hospitals and clinics normally send your medical record to a central depository two years after your last visit. Time for release. Whether your provider uses Epic or not, you can let them see your health record summary, medications, allergies, immunizations and health issues. We may charge a reasonable fee for copying of requested health information. Records Sent to a Doctor Fax. Please complete the form in its entirety, and sign and. 2 and in this Section, subject to the provisions of R. Requests take 30 days to process from the date they are received. If you would like to obtain a copy of your medical records, images or test results, we are here to help. You or your local military facility can legally request copies of these records. UNM SRMC may charge the following fees for medical records and. Need your medical records? Kaiser Permanente has made it easy for our members to request their Medical Rec-ord information online through kp. You can request a copy of your medical records: By calling our offices and asking that we mail you an Authorization to Release Healthcare Information form; By printing the Authorization to Release Healthcare Information form and faxing it to (207) 626-1175 or mailing it to MGMC Medical Records Department, 10 Water Street. You must sign the form by hand. If you have any questions about what type of ID is accepted, please contact HIM. Print a copy of the form, fill it out and return to. Fax: 909-558-2454. 8262 or email it to [email protected] The Health Information Management department can assist you with obtaining copies of your medical records from our facilities. Obtain a Copy of Your Medical Record or to Request a Copy of Your Bill. Information in your health record may be printed for you to take to a clinic or hospital that is not a part of Allina Health. Request Medical Records FROM The Iowa Clinic. There is no fee for this service. How much will it cost? The cost is dependent on the type of use. To start your request, simply download, print, complete, and sign the Authorization for Disclosure of Protected Health Information Form. Washington Hospital Healthcare System has been serving the community since 1958. It also provides statistical information for the medical and administrative staff. The record is maintained and retained by Health Information Management. It may be necessary to verify that the patient has actually died and the identity of the next of kin. Purpose of Release, i. Submit the completed authorization form in person or mail to the appropriate Medical Records Department where you received your care and treatment. Get, organize, and share your VA medical records online through our VA Blue Button tool. This is a safe and efficient way for us to track your health and give you better care. Requests are processed in the Centralized Release of Information office. The physician office must fax a written request on their letterhead to (478) 757-6427 indicating the patient's name, date of birth, date of visit in the facility, facility Name and place"STAT" at the top of their request. How to Obtain Medical Records: To request your medical records, please call (765) 660-6060, Monday through Friday, 8:00 a. Patients may request that their medical record information be released to themselves or other third parties for various reasons. , Room A88 San Francisco, CA 94143-0308. Requesting Medical Records. With Release to MyChart, your medical records can be requested and downloaded to your secure MyChart account at no charge. Print a request form here: Release of Information Authorization form. Keep reading to learn more and download forms. The department is located on the corner of Carpenter and 9th streets. request corrections to your medical records. The legislative intent of the low-cost medical records provisions via the HITECH Act was to knock down barriers between patients and their medical records. If your relative has passed away, you can request copies of his or her medical records by completing an authorization form. How to request information (by mail) To request a medical record, please print one of the forms listed in the column to the right, complete the requested information, sign, date the form, and mail it to the following address: VA Palo Alto Health Care System Release of Information (11MR) 3801 Miranda Avenue Palo Alto, CA 94304 You can also fax. All other HIPAA rules regarding an individual’s request for records flow from this simple statement of intent. You may request your records by: Completing the form electronically Mailing the form to Florida Medical Clinic Medical Records Department 2150 Via Bella Blvd. Requests for Medical Records. Request Medical Records The Health Information Management department can assist you with obtaining copies of your medical records from our facilities. A patient must request, in writing, a copy of medical records. However, we may charge a printing fee if you are requesting paper copies or other files for your own records. Medical Records Request Medical Records. Check off the "Medical Records" request option and the "Medical" option for the purpose of the request. , Suite 001 Chicago, IL 60612 Please allow 7 to 14 days for processing. Requests may be completed in less than one week if the request is for a medical need. QUICK RELEASE CONTINUING CARE – FOR HEALTHCARE PROVIDERS ONLY! If you are a healthcare provider (hospital, clinic, physician’s office) requesting patient medical records for continuing care, use our tailored Quick Release form to submit your request online quickly and easily. 005, except if the physician determines that access to the information would. Patients must request their records in writing. Requests for record copies may be submitted in person to the Health Information Management Department between the hours of 8:00 a. Find more information at:. Be sure to include the date of the release you want revoked, sign the letter, and send it (via mail, email or fax) to the location you received care. You may access our online request form. Our Family Medical Centers fulfill requests for release of medical records for all patients. , Monday to Friday. Luke's medical record. to download or print your medical records within 1-3 business days. Please note: All patient requests for TOA records will be processed by Record Reproduction Services. Written requests for copies of medical records for personal use will also be honored in compliance with Massachusetts General Laws. Please click below and follow the. Request Medical Records Please follow the links below to request your medical records: OU Physicians and OU Children's Physicians. Spaulding Rehabilitation Hospital Boston. How much will it cost? The cost is dependent on the type of use. has the right to request access to grant records or information except to the extent …. You may need to install Adobe Acrobat Reader in order to download our forms. You can request a copy of your medical records at any time, or register for one of our patient portals for direct access to your records. Obtaining a copy of your medical record is easy. Requests may be completed in less than one week if the request is for a medical need. The physician office must fax a written request on their letterhead to (855) 519-9683 indicating the patient's name, date of birth and date of. If you are requesting medical records, you will be required to bring a state-issued photo identification card and asked to complete the Authorization for Release of Information Request Form. Medical Records Sylvester Comprehensive Cancer Center (SCCC)For Sylvester Cancer Center Medical Records, please call (305) 243-5272 or send a fax to (305) 243-5274. To decrease the likelihood of a fax being sent to an unintended recipient or an individual, we do not fax medical information except in medical. Obtaining a copy of your Saint Mary's Health Network medical records is easy. You may request your records by: Completing the form electronically Mailing the form to Florida Medical Clinic Medical Records Department 2150 Via Bella Blvd. If you are a new patient, please request a copy of your medical records to be sent to your new Great Falls Clinic provider 2 to 4 weeks prior to your visit; we are happy to assist you with this process. If you would like to see or receive a copy of your medical records at University Health System, we are committed to completing your request in a timely manner. Copies of records may also be picked up from the hospital location that is most convenient for you. To request a hard copy of your medical records, complete a Medical Records Request Form and fax it to 920-262-4266, or drop your completed form off at Watertown Regional Medical Center. Medical Records & Release Forms The Health Information Management Department is dedicated to maintaining your medical records and keeping your health information private and secure in accordance with patient’s rights and federal and state regulations. Appendix A to this section contains a sample form which may be used to establish specific written consent for access to employee medical records. To obtain your medical records by mail, print and complete the Authorization for Release of Confidential Medical Record Request form below and mail the request to:. Please be sure this request is signed and dated by you. Find out how to use these forms to transfer or request copies of your medical records at Kaiser Permanente Washington Transfer and get copies of your medical records You have the right to view or get copies of your medical record (or your child's) for free. If you have any questions, please call us at 512-440-4075. Forms and instructions for requesting medical records are available in the next. Any ideas on how or where to go to get records of my complete medical history?. Written signed requests are processed and available within 10 business days. Medical records contain sensitive and personal information and are considered protected and confidential. Requests for records should be made on the “Authorization to Use or Disclose Protected Health Information” form. Requests for the release of medical records (protected health information) must be submitted in writing and must contain all the elements required by law. You can request a copy of your complete medical record or specific documentation. Make a Freedom of Information (FOIA) request for Airmen Medical records. Requests may be completed in less than one week if the request is for a medical need. The law requires that the authorization include the patient’s signature and the date the request is being authorized. Requests also can be emailed to [email protected] After completing and signing the form, ask the employee to send the form to Health Information Management through our inner-office mail system. org or call 855-788-6277 for an activation code. Accordingly, staff members treat your medical information in compliance with federal and state requirements. State and federal laws permit fees to be charged for copies of medical records. Get, organize, and share your VA medical records online through our VA Blue Button tool. To help us expedite your request for release of information please follow these steps: Fill out the medical records. At Los Alamitos Medical Center, we keep your healthcare information private. If you’d like a copy of your medical records, please contact or visit the Medical Records Office. Request for pick-up of medical record copies. However, most veterans and their next of kin can obtain free copies of their DD Form 214 (Report of Separation) and the following military service records any of the ways listed below. Request forms must be signed by patients 18 years of age and older. Or you may call 216. 5643 for hospital-related questions and 425. To request a copy of your medical records for a healthcare provider or third party, complete a Medical Authorization Form, and provide a copy of your photo ID. This is a safe and efficient way for us to track your health and give you better care. You may visit the medical record pick-up window at any of our 8 hospitals or mail or fax your request. medical records. Writing Your Medical Records Request Health Care There are many reasons why you might ask for copies of medical records for yourself or someone you care for, such as your child or other family member, ranging from curiosity to investigating a medical malpractice lawsuit. To request patient records, please email our Medical Records Department at [email protected] In some cases, you may be able to appeal the denial. Redlands Community Hospital Medical Records Services is located on the basement floor of the main hospital, across from the public elevators. By law, copies of records may take up to 30 days to receive, please call as soon as possible if you need your records for an out-of-town appointment. The physician office must fax a written request on their letterhead to (855) 519-9683 indicating the patient’s name, date of birth and date of. You may visit the medical record pick-up window at any of our 8 hospitals or mail or fax your request. Request Medical Records Print a request form here:  Release of Information Authorization form. edu or fax to: (844) 758-4931. Request your medical records. To function correctly, this application must be viewed. Each request for medical records is processed separately in direct response to the entity, location or physician specified in the request/authorization. After you complete, sign and date the authorization form(s), you can either. For immediate continuity of care, your healthcare provider can request records. Only patients or their legal representatives may make a medical record request. There's no charge for records faxed to a physician. You can access your medical records online and request additional medical records through your MyPinnacleHealth patient portal. Requested records are usually available within 2-3 business days for you to print or save electronically. Requesting Medical Records: All requests for the release of medical records must be submitted in writing and must be dated and signed by the patient or the patient's legally authorized representative. 524 which requires that any request made to access or transfer medical records must be completed within 30 days or a letter must be sent to the requestor stating why the records are delayed. They will promptly handle your request for medical records at MultiCare. Request Records By Mail, Fax, or Email. You must request a copy of your medical records from each individual health care provider you have visited. Our Release of Information staff will be happy to assist you with requests for your medical records. You may be responsible for any fees charged for copying or mailing medical records. Request Copies of Your Medical Records You can obtain a paper copy of your medical records from Rose Medical Center through our records partner CIOX. For immediate continuity of care, your healthcare provider can request records. Requesting a Copy of Your Records A copy of your medical records may be obtained by downloading and printing the form below and bringing it to your doctor's office, Butler Hospital's medical records office in the basement level of the Center House Building or by mail. Form must be completed in its entirety. If you have any further questions about your medical records, or any general questions about ECMC, complete and submit the contact form below and someone will respond in a timely fashion. The form must have an original signature, not an electronic signature. , you must first submit a completed, signed and dated authorization form (PDF) to us. Authorization Form An authorization form must be completed in its entirety to receive a copy of your medical records. You can receive your records in any of the following ways, and you just need to let us know your preference by checking the applicable box in the request form: Mail Your medical records will be processed by Ciox Health within 3-5 business days of receipt of your completed authorization form. Request Medical Records Health Information Management (HIM), also known as the Medical Records Department, is charged with custodial responsibilities for your medical record. If you have questions, please contact our Health Information Management (HIM) group at our hospital locations or your physician's office. Feel free to reach out and contact us if you have any questions or concerns. There are a number of possible reasons for this. Request a Copy of Health Records to be Sent to Another Doctor, Clinic or Hospital. Request Medical Records Patients who have received care at a Tennova Healthcare hospital may request copies of their medical record/health information by contacting the hospital where you recieved care. It is important that you keep this document for verification of birth until you receive the certified copy of your baby's birth certificate. Requests may be completed in less than one week if the request is for a medical need. Proper identification will be required. Questions About Medical Records What is a medical record? It is a record of the information during the course of a patient’s treatment. To request medical records by mail, fax or email, download, print, and complete our Authorization for Use and Disclosure of Protected Health Information [PDF]. I am requesting my medical records for reasons related to my health insurance. If you need copies or access to medical records, you must call the appropriate hospital's medical records department directly. Medical records of a deceased patient may be requested by the personal representative of the patient's estate If the deceased does not have a personal representative, his or her spouse may make a request. Electronic requests will not be accepted. Our Pathology Department can assist you with requests to send your pathology slides and reports for continued medical care or second opinion consultation. We consider this follow-up patient care. Records requested for personal use, attorneys, and insurance, other than for disability or workers’ compensation, will be billed prior to the release of the records. You may park in the Green parking lot and enter the building using the East entrance. When you come to pick up your medical records, please bring photo ID. You may access our online request form. Who is authorized to request release of medical records? The patient, if not a minor. If you are not a portal user, please register to proceed. You can access this information online through our patient portal, or request a physical copy by contacting us at (508) 363-5400. This can help you communicate better with your health care team. Authorization to Release Medical Information Form English | Spanish. If someone other than the patient is picking up the records, that person needs photo ID and an original signed authorization letter from the patient. This form will allow patients to authorize copies of their medical information to be released to person/ facility named. Request Your Medical Records. Patients who have received care at AllianceHealth Clinton may request copies of their medical record/health information by contacting the hospital and requesting an “Authorization for Release, Use and Disclosure of Health Records” form. 1, 2018, visit MyChart. Completed forms should be faxed to the Health Information Management office at (239) 304-5196. Medical records with no activity after two years are transferred and retired to the National Personnel Records Center (NPRC), Saint Louis, Missouri. A Medical Records Request can help you get ahold of your medical documents when you need them. In order to obtain copies of your medical records dating before October 13, 2013, please fill out this Medical Record Release form. 6651 for assistance. To obtain a copy of your medical records, please complete the form below and return it via fax or mail to Southeast Georgia Health System Medical Records department, along with a copy of a current government issued photo ID. Our Release of Information (ROI) Office will be happy to assist you with requests for your medical records. One complete set of records will be provided to the patient or his/her representative at no charge. Find out how to use these forms to transfer or request copies of your medical records at Kaiser Permanente Washington Transfer and get copies of your medical records You have the right to view or get copies of your medical record (or your child's) for free. It also provides statistical information for the medical and administrative staff. Unless you are a parent or guardian requesting notification of or access to a minor's medical record, you must make a request for a medical record in accordance with this section. Authorization to Use and/or Disclose Protected Health Information. You may also request your records in person. Request for Medical Records. to answer your calls. Sanford Health Release of Information is dedicated to preserving the privacy and security of your health information while ensuring its availability for continuing care, payment, personal needs or other uses. ask for a copy of your medical records. Please fill out both sides of the form. Request for Medical Records Authorization Form. Manage your healthcare logistics online. To get copies of archived records send a request with the following information:. If you want Children's Mercy to send medical records to another organization, use the following forms: Authorization for release of medical information by Children's Mercy. Make a Request To receive a copy of your medical record, print out and complete our authorization form below and mail or fax it to the hospital or facility where you received service. How to Get Medical Records. Request Your Medical Records. There is no fee for this service. Monday through Friday. Children’s Minnesota supports your legal rights and gives you access to the medical record free of charge. For assistance with your medical records request Please contact the Washington University Health Information Release Service at (314) 273-0453. Army medical records are the property of the Government. They are kept separate from the patient’s medical and billing records. For example, your medical records may not make it clear how much of your injury is the result of an accident and how much is the effect of a preexisting injury. A fee for copying will be charged. Request Your Medical Records. Medical Records Request. Requesting Medical Records New Brunswick Campus. You may also pick them up in-person with a valid driver's license. You can access this information online through our patient portal, or request a physical copy by contacting us at (508) 363-5400. To obtain copies of your medical records, please see the information below based on where you received your care. It is often described as the law that keeps citizens in the know about their government. How to request a copy of your medical records. • Conforms to procedures for medical records requests established by Ohio statute. To request copies of your medical records, please complete an authorization form and mail it with a copy of your driver's license to one of the health information management department addresses listed below. To request a copy of your clinic medical records, complete an Authorization for Release of Patient Heath Information form, and submit it to the Health Information Management Department at the clinic. Medical records will be obtained from other health facilities when requested by a physician and upon written authorization of the patient. Request Medical Records. To receive more detailed information on submitting a request for medical records, please click on the link below that best describes who you are. Medical records of a deceased patient may be requested by the personal representative of the patient's estate If the deceased does not have a personal representative, his or her spouse may make a request. Requests should be sent from your insurance company, attorney, or Disability Determination Service and mailed to the address below. Our Release of Information (ROI) staff will be happy to assist you with requests for your medical records. The patient medical record is a strictly monitored, confidential document. 76315 between the hours of 8 a. You can access this information online through our patient portal, or request a physical copy by contacting us at (508) 363-5400. Register for MyChart here or call (404) 616-5551 to activate your account. Print and complete the Authorization for Disclosure of Health Information form: English (PDF) Spanish (PDF) The release form must be completed, dated and signed; We ask that you specify what components of your medical records you wish to obtain/release. Requests for Medical Records. be notified about how your information may be used or shared. If you desire to receive a copy of your medical records: Step 1: Complete the Request for Medical Records form (below) to make your pick-up. If there is a charge associated with releasing these medical records, please submit a billing statement with the records and payment will be remitted promptly upon receipt of the. Our office is open Monday through Friday from 8:00 am to 4:30 pm. Request Your Medical Records. All requests must be sent via the correct form, we cannot accept requests via email or phone. Please allow 24 hours to process Radiology scans to CD. Request Military Service Records. City of Hope maintains records for two separate entities: City of Hope National Medical Center and City of Hope Medical Foundation.