Patients may request a copy of their medical record from Huggins Hospital or ask the hospital to release a copy to a third party by contacting our Health Information Management Department (603) 569-7541 or by e-mail at email@example.com.
In order to request a copy of Your Medical Records:
Print and complete a Request for Medical Records form.
In order to release a copy of Your Medical Records:
Print and complete an Authorization to Disclose Protected Health Information form.
In completing the form:
Review the form thoroughly. If it's not completed appropriately, the transfer of the information will be delayed.
Indicate to whom you'd like the information released to.
Indicate the dates of treatment for the information. This is particularly important for people who have been cared for by Huggins Hospital multiple times.
- Indicate the format of how you would like to receive the information (paper, electronic data storage device or e-mail).
- Indicate the type of records needed.
- Indicate if a personal representative will be picking up the records for you.
- Review sections 6 & 7.
- Sign and date.
Submitting a Request
Once the form has been completed, it can be submitted by one of the four following methods:
1. Bring the form in-person to the Health Information Management (HIM) office. The staff at the Information Desk in the Huggins Hospital Main Lobby can give you directions. Hours are Monday through Friday, 7 AM to 5 PM, except holidays.
2. Mail form to:
Health Information Management Office
240 South Main Street
Wolfeboro, NH 03894
3. Fax form to: 603.569.7542 Attn: Release of Information.
4. Attach the request to an e-mail and send it to: firstname.lastname@example.org