Your Medical Records and Privacy
Request Your Medical Records
Print out and complete the appropriate Authorization of Release form:
Stamford Health System Authorization Form
You can access portions of your medical record through your Patient Portal.
We 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 English | Spanish| Haitian Creole | Russian | Polish | Brazilian Portuguese.
How to Request Medical Records
Patients treated at Stamford Health, which includes our physician practices, can request a copy of their medical records. The designated Health Information Management department will process your request. You will need to complete a HIPAA compliant authorization and a photo ID will be required.
Please mail the signed authorization to:
One Hospital Plaza Drive
Stamford, CT 06902
Or fax it to 203.276.7327.
For questions, please call 203.276.7455.
All requests will be processed within 30 days but are usually completed within 7-10 days. Please provide your phone number and we will contact you if we are experiencing a problem with your request. Records will be mailed to the address specified on the authorization. You may also pick them up at Health Information Management located at Stamford Hospital with a photo ID. Please call 203.276.7455 to make arrangements.
Requests for Stamford Hospital Medical Records
Services provided at the Hospital, Urgent Care centers, Tully Health Center, physical therapy locations and radiology reports will be processed by the Hospital's Health Information Management department. Please mail the request to the address on the authorization or fax it to 203.276.7327. For questions, please call 203.276.7455.
All requests will be processed within 30 days, but are usually completed within 7-10 days. Please provide your phone number and we will contact you if we are experiencing a problem with your request. Records will be mailed to the address specified o the authorization. You may also pick them up at Health Information Management located at Stamford Hospital. Please call 203.276.7455 to make arrangements.
Records can be released to anyone the patient authorizes in writing to receive such information. The authorization must include the following:
- Patient's full name and date of birth (list any other names the patient may have had).
- Medical record number (if available).
- Specific information requested (i.e. type of report/information and dates of service; for the medical group the name of the group practice and/or the name of the provider).
- Purpose for which the information may be disclosed (i.e. personal use, continuity of care, legal matter).
- To whom the information is being 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:
- Legal guardianship papers
- Advanced Directive/Healthcare Power of Attorney, for patients unable to make healthcare decisions.
- Designation of Personal Representative Form, which allows the representative to act on the patient's behalf with regard to personal health information.
- Date of the signature
Please note that unsigned requests will not be processed.
Requests for Radiology Images
Please contact the Radiology department at 203.276.7038.
Requests for Pathology Materials
Pathology slides and blocks can be release by contacting the Department of Pathology at 203.276.7420. Please note, pathology requests need to be made directly to the Department of Pathology. Medical Records cannot provide this information.
Requests for Birth or Death Certificates
Requests for medical records of a deceased patient requires a copy of the death certificate or evidence of next of kin or executorship of the estate. Please contact the Vital Statistics department, Stamford Government Center, 888 Washington Blvd in Stamford or 203.977.4054.
Requests for Continuing of Medical Care
Pertinent information is routinely released free of charge and will be mailed or faxed directly to the physician or facility, depending on the urgency of treatment. Requests for emergency treatment will be accepted by phone from physicians and facilities and faxed urgently.