Request Medical Records

10/28/2016

Medical Records Request Form (PDF)

The Medical Records Department is responsible for the organization, storage and retrieval of all patient medical records.

If you require records, please call our correspondence secretary at 845.987.5193, Monday through Friday from 8 a.m to 4 p.m. You will be required to sign an authorization before records will be released. In some cases, identification is required. If the records are for your own use, there is a charge of $0.36 per page.

When requesting medical records, it is helpful if you have the following information when you call or visit the Medical Records Department:

Name of patient
Address of patient
Phone Number
Date of birth
Date(s) of service
Where service performed (what hospital department)
Reason for copies
When copies are needed
Where copies are to be sent
The Medical Records Department is located on the basement level of the hospital

Authorization for Release of Health Information (Including Alcohol/Drug Treatment and Mental Health Information) and Confidential HIV/AIDS related Information

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