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Request Medical Records

Patients treated at Yale New Haven Health hospitals can request a copy of their medical records by faxing, emailing or mailing a signed Authorization for Release of Information form, as indicated on the authorization.

Important: When filling out your form, be as specific as possible with what information you would like from your medical record. Be sure to include your/the patient's date of birth, current address, current phone number and dates of service.

Copies of medical records will be provided to patients (or their legal representatives) at no cost. All other requests for medical records will be provided in accordance with the state rate for copies of medical records.

Use the instructions for your provider in the sections below:

  

For Bridgeport, Greenwich and Yale New Haven hospitals

We encourage you to use our secure online form to request medical records. The form only takes a few minutes to complete. Please have a copy of your government or photo ID ready.
  

 

 

OR

 

pdf Download this PDF formPrint the form, complete and sign, then fax or mail it to:

Health Information Management
Release of Information Services
PO Box 9565
New Haven, CT 06535
Fax: 203-688-4645
Email:
[email protected]

For X-rays or other radiological images, call 203-688-6054. Fax completed forms to 203-688-4645.

For Lawrence + Memorial Hospital


pdf Download this fillable PDF form  and complete it. Print the document, sign it, then fax, email or mail it to:
Lawrence + Memorial Hospital
Health Information Management
365 Montauk Ave, New London, CT 06320
Fax: 860-444-3760;
Email: [email protected]

For X-rays or other radiological images, call 860-442-0711, ext. 2578.

For Northeast Medical Group

We encourage you to use our secure online form to request medical records. The form only takes a few minutes to complete. Please have a copy of your government or photo ID ready.
 

 

 

OR

 

pdf Download this PDF formPrint the form, complete and sign, then fax or mail to::
Health Information Management 
Release of Information Services
PO Box 9565
New Haven, CT 06535
Fax: 203-200-1286
Email: [email protected]

For X-rays or other radiological images, call 203-688-6054. Fax completed forms to 203-688-8812.

For PhysicianOne or Yale New Haven Health Urgent Care

We encourage you to use our secure online form to request medical records. The form only takes a few minutes to complete. Please have a copy of your government or photo ID ready.
  

 

 

OR

 

pdf Download this PDF formPrint the form, complete and sign, then fax or mail it to:

Health Information Management
Release of Information Services
PO Box 9565
New Haven, CT 06535
Fax: 203-688-4645
Email:
[email protected]

For X-rays or other radiological images, call 203-688-6054. Fax completed forms to 203-688-4645.

For Westerly Hospital


pdf Download this fillable PDF form  and complete it. Print the document, sign it, then fax or mail it to:
Attention: Medical Records
25 Wells Street
Westerly, RI 02891
Fax: 401-348-3774
Email: [email protected]

For X-rays or other radiological images, call  401-348-3292 or fax 401-348-3488.

For Yale Medicine Providers

We encourage you to use our secure online form to request medical records. The form only takes a few minutes to complete. Please have a copy of your government or photo ID ready.
 

 

 

OR

 

pdf Download this PDF form. Print the form, complete and sign, then fax or mail it to: 
Yale New Haven Health
Health Information Management 
Release of Information Services
PO Box 9565
New Haven, CT 06535
Fax: 203-200-1287
Email: [email protected]

For X-rays or other radiological images, call 203-688-6054. Fax completed forms to 203-200-1287.

Customer Service Locations

 
Yale New Haven Hospital
West Pavilion
20 York St, Suite 108
New Haven, CT  06519
Hours: 8 am to 4:30 pm M-F
203-688-2231
 
Medical Center South
100 Church St. South
Medical Records, Suite 300
New Haven, CT  06519
Hours:  8 am to 4:30 pm* M-F  
203-688-2231
*Until 7 pm Wednesdays 
  
Bridgeport Hospital
267 Grant Street
Bridgeport, CT  06610
Hours: 8 am to 4:30 pm M-F
203-688-2231

Bridgeport Hospital Milford Campus 
300 Seaside Avenue
Milford, CT  06460
Hours: 8 am to 4:30 pm M-F
203-688-2231

Greenwich Hospital
5 Perryridge Road
Greenwich, CT  06830
Hours: 8 am to 4:30 pm M-F
203-688-2231

Lawrence + Memorial Hospital
365 Montauk Avenue
New London, CT  06320
Hours: 8:30 am to 4 pm M-F
860-442-0711

Westerly Hospital
25 Wells Street
Westerly, RI  02891
Hours: 8 am to 3:30 pm M-F
401-348-3262

All offices are closed holidays and weekends

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