Your Medical Records and Privacy

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.

Request Medical Records Important Information

All requests received via form 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 photo ID is required. Please call 203.276.7455 to make arrangements.

Hospital and Physician Practice Records

Services provided at the Hospital and at the Stamford Health Medical Group will be processed by the 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.

Records will be released to anyone the patient authorizes in writing to receive such information. The authorization must include the following:

  1. Patient's full name and date of birth (list any other names the patient may have had).
  2. Medical record number (if available).
  3. 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).
  4. Purpose for which the information may be disclosed (i.e., personal use, continuity of care, legal matter).
  5. To whom the information is being released to (name and address).
  6. The patient or a patient's legally appointed representative (i.e., Parent for minors, POA, Conservator) must sign and date the request.  
  7. Authorizations signed by a representative must be verified. Please include a copy of one of the following documents indicating either:
    a. Legal guardianship papers
    b. Advanced Directive/Healthcare Power of Attorney, for patients unable to make healthcare decisions.
    c. Designation of Personal Representative Form, which allows the representative to act on the patient's behalf regarding personal health information.
  8. 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. Stamford, CT or 203.977.4054.

Requests for Continuing of Medical Care

Pertinent information is routinely released 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 phone, then followed up with a written request on the providers fax cover sheet, records will be faxed urgently.

1. Patients may access portions of their medical record through the Patient Portal.

2. If you do not see what you are looking for in the Patient Portal or if you prefer a copy of your medical records use MRO Express to request records electronically.


3. If you prefer to request records using a form, print out and complete the appropriate form:

Release of Information Authorization Form English or Spanish

Please send the signed authorization form to the Health Information Management Department. Copy of photo ID is required.

Mail, fax, or visit
Stamford Health
HIM Department
One Hospital Plaza
Stamford, CT 06902

Monday – Friday 8am -5pm, Saturday and Sunday closed.

  • Fax  203.276.7327
  • Main Line  203.276.7455
  • Portal Line  203.276.7034

Request Your Medical Records

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