Request Your Medical Records
Complete our authorization to disclose protected health information form.
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It's a good idea to keep copies of your medical records. You'll need them if you change doctors, move, get sick when you're away from home, or end up in an emergency room. If any of these things happen and you have your records, you may get treatment more quickly, and it will be safer.
How to Request Copies of Your Medical Records
To request copies of your medical record for your own use or to disclose to health care providers, insurance companies, attorneys or other third parties, you must make your request in writing by completing our authorization to disclose protected health information form. If you have questions contact Health Information Management Services (HIMS) at (603) 228-7312 or send email to firstname.lastname@example.org.
We may utilize a trusted business associate to fulfill your request in compliance with state and federal regulations.
Completing the Authorization Form
To complete either the paper authorization to disclose protected health information or to submit the electronic request via Patient Connect:
Check the “purpose” as “Personal Records;”
For records to be sent to another person or organization: complete “Send/Disclose” information;
The name and address and phone # of the person or organization to send the records to;
Complete the “purpose;”
Complete the “type of info requested;"
Complete “Dates of care to be released.” (You may not request future dates.);
Certain types of sensitive information may be specifically excluded by initialing the type;
Complete the authorization expiration date if different than six months from signature date;
- Sign and date the form.
How We Use Your Health Information
We primarily use electronic medical record systems to capture medical information in both the inpatient and outpatient settings. These systems allow your information to be available to:
- Your healthcare providers and staff at Concord Hospital;
- Concord Hospital Medical Group Practices;
- Other providers who are involved in your care such as:
- Primary care providers;
- Specialty care providers;
- Consulting providers;
- On-call providers;
- Emergency/urgent care providers;
- Hospitalists and other hospital-based providers;
You do not need to complete an authorization form for these providers to access the health information in your EMR related to your medical treatment.
Frequently Asked Questions
Do you provide copies of birth certificates?
No. The Concord City Clerk's Office provides certified copies of birth records to immediate family members for births that occurred in Concord, NH prior to 1989, as well as for births that occurred in any city or town in the State of New Hampshire after 1988.
What happens to my information after it is released?
You can ask the receiver of this information how it is used and stored.
How much information do you send for each request?
We limit the information sent to the minimum necessary for the purpose stated in the request. You may specify on the request form that specific information not be disclosed.
Can I obtain a copy of medical records other than my own?
Generally, you may not. There are some exceptions. You will need to provide written documentation to verify any of the exceptions:
- If you have written authorization from the patient.
- If you are the patient's legal guardian.
- If you have been appointed by the patient as their legal representative.
- If the patient is under 18 and you are the parent or legal guardian.
How can I obtain copies of my medical records related to the services provided by my physician at his/her office?
You can call Health Information Management Services at (603) 228-7312 and ask about requesting your records from your specific Concord Hospital Medical Group practice. Health Information Management Services will explain the process you need to follow. If the practice is owned by Concord Hospital, you will be able to use our Authorization To Disclose Protected Health Information form.