How To Receive Copies Of Your Medical Record

STEP 1: Authorization Release Forms

The information contained in the patient's medical record is confidential. All requests for release of medical records information must be accompanied by an authorization form and signed by the patient. The form must have an original signature.

Click here to download a printable version of the authorization form.  NOTE: Adobe Acrobat Reader is required to print form. Click here to download a free version of Adobe Acrobat Reader

STEP 2: Submit Request (Authorization Release Form)

Please mail, fax or deliver in person your authorization release form to:

Mail/Hand Deliver:
University of Maryland Medical Center
Department of Health Information Management
22 South Greene Street
Baltimore, Maryland 21201

Fax Numbers:
Monday - Friday
8:00 a.m. - 4:30 p.m.: 410-328-2358 (for emergency patient care only)
All other requesters may fax their requests to 410-328-0537
After normal business hours: Please call 410-328-6750 before faxing a request.

STEP 3: Receive Invoice

Fees:
Payment is required before medical record information is released.
You will be charged:

Base Charge (to cover supplies and labor): $22.18
+ Per Page Charge: $0.73 per page
+ Postage

When you receive your invoice please mail or deliver your payment (with the remittance portion of the invoice) to:

University of Maryland Medical Center
Department of Health Information Management
22 South Greene Street
Baltimore, Maryland 21201

Please make all checks payable to: University of Maryland Medical Center

STEP 4: Receive Records

You should receive your records within 10 days of receipt of your payment.

If you do not receive your records within 10 days, please call 410-328-5706 and select Option 2 to reach an ROI technician.

If you receive a Customer Service Card with your record please return this prepaid postcard to us with your comments, we strive to provide excellence to all our customers.

This page was last updated: May 20, 2013

         
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