How to request your medical record
You can request information from your medical record in these formats:
- Paper (there is a copy charge per page) – you will complete the first form below
- Electronic - via email – you will complete both forms below
Authorization of Use and Disclosure of Health Information - complete for both paper and electronic records
Request for Alternative Communication of Protected Health Information via Email - complete for records via email only
Once the forms are completed, please mail to address listed on the form, email to email@example.com , or 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.