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 Access/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.
 

For Bridgeport, Greenwich
and Yale New Haven hospitals
or Northeast Medical Group

pdf Download this fillable PDF form and complete it.

Print the document, sign it, then fax, email or mail it to:

Yale New Haven Health
Health Information Management 
Release of Information Services
PO Box 9565
New Haven, CT 06535
Fax: 203-688-4645
Email: releaseofinfo-Hosp@ynhh.org

For Yale Medicine Providers:
Fax: 203-200-1287
Email: releaseofinfo-YM@ynhh.org

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

 

For Lawrence and 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: releaseofinfo@lmhosp.org

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

 

For Westerly Hospital

pdf Download this fillable PDF form and complete it.

Print the document, sign it, then fax or mail it to:

Westerly Hospital
Attention: Medical Records
25 Wells Street
Westerly, RI 02891
Fax: 401-348-3774

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