Request Medical Records

The following people are authorized to request your health information on your behalf (proper identification will be required):

• Health care representative if the patient is unable to sign (a legal document must be provided.)
• Parent (if the patient is younger than age 17)
• Legal Guardian (proof of guardianship document must be provided.)
• Administrator or Executor of the estate for deceased patients (copy of documentation required). In lieu of Executor documentation, a letter from the Probate Court indicating a Probate was not opened (authorization and proof by the next of kin is required).

Middlesex Health provides patients a copy of their medical record at no charge.

There is also no charge for copies of medical records for the following situations:

• Medical Records released for continued care to other healthcare providers.
• Medical Records released to a patient's attorney or authorized representative for the purpose of supporting a Social Security claim or appeal and the request is accompanied by documentation of the claim or appeal.
• Medical Records to support Worker’s Compensation cases as authorized by and to the extent necessary to comply with laws relating to Workers’ Compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.

Laws regarding patient and patient-directed requests have recently changed and now require processing within 15 business days, according to the 21st Century Cures Act, in the form and format requested by the patient.

Yes, Middlesex Health can provide you with a copy of your medical records in electronic form and format you request, if readily producible in that form and format.

Yes, if the information has not already been released, you may revoke your request in writing by downloading and completing the Revocation of Release of Information Form (Revocación de la autorización de divulgación de información) or you may revoke your request via a written letter.

You may submit the form by fax to: 860-358-6366, by email to: release_of_information@midhosp.org

or by mail to: 

Middlesex Health
28 Crescent Street
Middletown, CT 06457
Release of Information Unit

We will place the original request on hold unless previously acted upon.

If you have questions about how to have medical records amended, please contact the Health Information Management Department at 860-358-6222, option four. Please leave a message with detailed information. A staff member will return your call within one business day.

If you would like to initiate an amendment or correction to your medical record, please click here to print the "Request for Amendment/Correction of Protected Health Information" form.

Please note that it is unlawful to remove any portion of your medical record. For that reason, any changes made will be in the form of an addendum. Federal law allows 60 days to respond to this type of request, unless notification is provided to the patient of the need for a 30 day extension.

You may request a copy of your legal medical record as outlined above. Please specify if you need the copy of your medical record to be certified or notarized.

If you have any questions, please contact the Health Information Management Department at 860-358-6222 option four. Please leave a message with detailed information. A  staff member will return your call within one business day. You may also email your question to release_of_information@midhosp.org