Medical Records & Privacy
Request Your Medical Records
Print out and complete the appropriate form:
1. Medical Release Form: Stamford Hospital. Mail to address listed on form, and indicate: "Release of Information Specialist
Health Information Management Department"
2. Medical Release Form: Stamford Health Medical Group. Mail to address listed on form.
Note: Please include a photocopy of your driver's license or a valid ID with the form.
You can also access the release form through your Patient Portal.
Questions? please contact our Health Information Management department at 203.276.7034.
We’re happy to honor your requests for medical records should you need to access them at any point. We also respect and treat your privacy seriously when handling your confidential medical information. The information below outlines some important areas to note and actions to take.
Joint Notice of Privacy Practices
This joint notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully in either English or Spanish.
Requesting Copies of Your Medical Records
Records can be released to anyone who the patient authorizes (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 (list any other names the patient may have had)
- Medical record number (if available)
- Specific information being requested (i.e., type of report/information and dates of service, etc.)
- Purpose for which the information may be disclosed (i.e., personal use, continuity of care, legal matter)
- To whom the information is to be sent (name and address)
- Specify authorization’s expiration date if desired (otherwise, the authorization will be valid one year from date signed)
- The patient’s signature or a patient’s legal representative’s signature. Authorizations signed by a representative must be verified. Please include a copy of one of the following documents indicating either:
- Please note that unsigned requests will not be processed
- Date of the signature
Requests for medical records of deceased patients require a copy of the death certificate or evidence of next of kin or executor-ship of the estate. Please also include your phone number in case we need to contact you for additional information concerning your request.
Requests to Keep Records for Personal Files
- Please follow the instructions above
- Please allow reasonable time to process your request. We will contact you in the event we experience unforeseen delays or are unable to fulfill your request.
- Records will be mailed to the address specified on the authorization form, or you may pick them up at our office if you make arrangements with the Release of Information Staff. For security reasons, please be prepared to show proper photo identification.
Requests for Continuing Medical Care
- Medical emergencies will be faxed free of charge directly to a physician or medical facility.
- Continuing care requests are also free of charge and will be mailed to your clinic/physician(s) prior to your appointment (please indicate the date of your appointment on the authorization form so that the copies are received early enough for your physician to review).
- Pertinent information such as radiology/imaging, history and physical, consultations, operative reports, and discharge summaries are routinely provided to the physician for continuing care.
Requests for X-Ray Films
Please contact our Radiology/Imaging Department for films, at 203.276.7038.
Requests for Birth Certificates/Death Certificates