Medical Records Request

Medical Records Requests

Any requests for or inquiries about patient medical records should be directed to the Health Information Management Department at 508-334-5700 or email medctrmr@umassmemorial.org.

Correcting Your Medical Record If you believe information in your medical record is incorrect, please complete the "Request to Amend Protected Health Information" form.

Your medical record is the physical property of the UMass Memorial Health clinical entity where you received your care. You have the right to review the record and to obtain a copy.

When you are discharged from any UMass Memorial Health entity, your medical record still must be completed by all providers involved in your care prior to being copied and released to you. This process can take up to 30 days. When needed, information may be released to a physician or medical facility for any follow-up and continued care you receive.

How to Request Your Medical Records

If you wish to receive a copy of your medical records for yourself, we encourage you to sign up for a MyChart account and follow the instructions to request records to your portal.  We cannot send records to a third party using the MyChart portal.

If you wish to receive a copy of your medical records or have the records forwarded to another party, please complete the Authorization for the Disclosure of Protected Health Information Form below. 

Through Authorization Form: If you need a copy of your records or want them sent to someone else, please complete the Authorization for Disclosure of Protected Health Information form in your preferred language below:

• English
• Spanish
• Portuguese
• Albanian
• Vietnamese
• Arabic
   

Completing the Authorization Form: 

Please make sure that the authorization is filled out completely for your request to be complied with in a timely manner:

• Mark with a check, any boxes relating to which facility/facilities you would like to Release records. Please note, if you are selecting UMass Memorial Medical Group, you must provide the physician’s name in the location.
   
• Fill out all the Patient Information: (You are not required to provide the Medical Record Number)
   
• Mark with a check whether the request is to Request & Receive or Release records or check if you would like the records mailed to the patient’s address provided in the Patient Information section.
   
• Enter the Name and all contact information to whom the records are being sent.
   
• Mark with a check the Purpose of the request. 
   
• Mark with a check either Abstract or Encounter of a specific date range of the records requested or specific services.
   
• In Specific Services, please make sure that you check off the types of documents you wish to receive.
   
• In the Protected Under State or Federal Law section, mark with a check any of the boxes if relevant to your request.  If your record contains any of this information, we will not be allowed to release.       
   
• Specify how you wish to receive your records: mail, email, portal (if your MyChart account is active) or fax.
  
  If you wish to receive your records via email, please make sure to provide your email address clearly on the form or it may delay the process.  
   
• Pick up locations are:
  • University Campus, 55 Lake Avenue North, Worcester
  • Health Information Management, 67 Millbrook St, Suite 200, Worcester
  • HealthAlliance-Clinton Campus, 60 Hospital Road, Leominster
     
• Sign and date the authorization. 
   

Send Completed Forms to:

Email: medctrmr@umassmemorial.org

Fax: 508-334-9717

Address: UMass Memorial Health
c/o HIM Department
67 Millbrook Street, Suite 200
Worcester, MA 01606

Health Care Proxy Agents

If you are requesting records as a HCP agent, the health care proxy must be invoked by a provider and must be made for continuing care purposes.

Deceased Patients’ Medical Records

 If you are requesting an autopsy or medical records of a deceased patient, you must submit an authorization along with one of the legal documents obtained through the Probate Court: 

• Court appointment as Executor of Estate/ Letter of Authority for Personal Representative
• Court Appointment as Voluntary Administrator/ Attested copy of Voluntary Administration Statement

Billing Records

Contact our Billing department at 508-334-1840.

Radiology Images

Contact our Radiology department of the facility the services were provided:

• Harrington: 508-765-3030

• HealthAlliance-Clinton: 978-466-2689

• Marlborough: 508-486-5600 

• University Campus: 774-441-8406

• Memorial Campus: 508-334-6131

A fee for photocopies may apply per Massachusetts General Law, Chapter 111, Section 70.”  Upon receipt of a signed Authorization Form, UMass Memorial will process the request within seven to ten business days and send an invoice for payment of the copies.  Please note:  Some requests may take up to 30 days.
 

Milford Regional Medical Records: 

Visit the Milford Regional Medical Center Medical Records Department or call 508-422-2487.

Questions?

If you have any questions, please contact the Health Information Management department directly:

• By phone: 508-334-5700 and respond to the menu prompts to reach additional assistance
• By email: medctrmr@umassmemorial.org