How to request your medical record
You may electronically request your medical record, or you may print forms and mail them to request your medical record.
To request your medical record electronically and have the request sent automatically to be processed – please select the button below for the type of records being requested. You may need to complete multiple requests. [note - you will need to upload documents for ID]
To print and mail, email or fax your request, please complete the following form(s).
If you are requesting a paper copy or CD of your records, print and complete the appropriate form(s) below.
- Authorization of Use and Disclosure of Health Information
- Comprehensive Opioid Addiction Treatment Authorization
- Authorization to Disclose Psychotherapy Notes
Mail forms to address listed on form.
Email to firstname.lastname@example.org
Fax to (304) 388-1195
Proof of identity is required when you pick up medical records in person (driver's license or other government issued photo ID).
The patient or the patient's legal representative must sign the Authorization of Use and Disclosure. If you are the patient's legal representative, we require proof that you may sign on behalf of the patient (example: Copy of the Medical Power of Attorney papers).
Sending your records to another provider
If you need information from your medical record sent to another provider, please call (304) 388-1300. There is no charge for this service. (A provider is someone who is providing professional medical care for you. An example would be a specialist to whom you have been referred.) Please provide the name, address, phone and fax number of the physician/provider to whom you want the information sent.
The release of information office is currently closed to in-person traffic due to COVID-19. You can reach the office to request records by calling (304) 388-1308.
Please refer to the CAMC Notice of Privacy Practices for more detailed information regarding how medical information about you may be used and disclosed.