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Medical Records Requests

 

Your medical record itself belongs to the hospital, but as a patient, you have the right to review and/or obtain a copy of your own medical information. Patient-related information may also be released to a physician or medical facility for care of the patient when needed. Our process for requesting medical records varies slightly by location. Please see details below.

Your Medical Record Requests

To review or receive a copy of your medical record or to have your medical record forwarded to another party please fill out the form below:

Authorization for the Disclosure of Protected Health Information (English)
Authorization for the Disclosure of Protected Health Information (Spanish)
Authorization for the Disclosure of Protected Health Information (Portuguese)
Authorization for the Disclosure of Protected Health Information (Albanian)
Authorization for the Disclosure of Protected Health Information (Vietnamese)
Authorization for the Disclosure of Protected Health Information (Arabic)

A fee for photocopies may apply per Massachusetts General Law, Chapter 111, Section 70.”  Upon receipt of a signed Authorization Form, UMass Memorial will process the request within seven to 10 business days and send an invoice for payment of the copies.

If you have questions, please call Health Information Management at 508-334-5700, option 1, or send an email to medicalrecords.medctr@umassmemorial.org. You can send your request in via fax as well to 508-334-9721.