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Medical Records

If you would like to obtain a copy of your medical records, images or test results, we are here to help. To ensure privacy, we require that all request forms be signed and dated by the patient or the patient’s legally authorized representative, parent or guardian. If the patient is under psychiatric care, the supervising psychiatrist will be required to sign the form. For more information about our legal requirement to maintain the privacy of your health information, see our Patient Privacy Notice

Obtain a Copy of Your Medical Records, Images or Test Results

• To determine the correct form you will need, refer to the Medical Record chart below.

  There is no cost if medical records are being sent directly to another healthcare provider or physician for the purpose of continuing care. The fee for copies requested for personal use is $1.00 per page and advance payment is only required if the total cost will exceed $100.00. Please allow 3 to 5 business days for processing time.

  Medical Record	Department or office	Form
  Patient Medical Records Radiology (typed report) (typed report)	Health Information Management (HIM) Office Choose the hospital where you received care, below.	Authorization to Obtain Information
  Radiological Images Including X-ray, MRI	Radiology & Medical Imaging Choose the hospital where you received care below.	Authorization for Release of Radiology/Imaging Films
  Mammography Including breast ultrasound, screening and diagnostic mammography(images on CD)	Breast Health Services/Mammography Imaging Department Choose the hospital where you received care below.	Authorization for Release of Radiology/Imaging Films
  EEG Lab Result EEG (images on CD)	EEG Lab Choose the hospital where you received care below.	Authorization for Release of Radiology/Imaging Films

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