University of Rochester

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Last modified: Monday, 12-Mar-2012 13:36:55 EDT

University Health Service (UHS)

Medical Records
Authorization for Release

Medical information is routinely exchanged between healthcare professionals as deemed necessary by your healthcare provider to assure your safe, continuous care. This information includes records sent to specialists, to emergency departments, hospitals, etc. There is no charge or special patient authorization required for this process.

Immunization Record Release

If you are requesting a copy of your immunization records only, you can submit your request by e-mail to hhf@uhs.rochester.edu. No other form or signature is required. Generally, immunization records are copied and mailed within 3-5 business days.

Authorization for Release of Your Medical Record

Requests for copies of your University Health Service (UHS) medical record must be made in writing, must include your original signature, and must be hand-delivered, mailed, or faxed to UHS. You will need to complete the UHS Medical Record Release Form.

Medical Records Release Form– For release of UHS medical records.
PLEASE NOTE: For the release of medical records from the University of Rochester Medical Center (URMC) or Strong Memorial Hospital, call 585-275-2605 (Strong Health Information Management).

The following information is required to assure the correct information is released:

Your full name (if you are married and had a different last name when you were at the University of Rochester, please give your maiden name, as well).
Your date of birth. If you were a student and remember your student ID, please include it.
The dates/years and your status (e.g., full-time or part-time student, employee, or both) when you were at the University.
The complete address, phone number, and fax number, if available, where you want the information mailed. Quite often this is a physician's office address or school health office.
Your address, e-mail address, and/or phone number. This information is useful if we need to contact you about your request.
If you are under age 18, your parent or guardian's signature is required in addition to your own. Requests for other than direct patient care generally take between 7 and 10 working days.

Fees

There is no charge for immunization histories, or records that are delivered (via fax or mail) directly to another doctor's office or medical care provider. There is a charge for records requested for personal reasons. The fee is $.75 per page or a flat $10.00 for 15 pages or less. Pre-payment is required prior to the release of the records. If requesting records for reasons other than direct medical care (e.g., insurance companies, attorneys), the requestor is responsible for payment of records.

Contact

E-mail:     hhf@uhs.rochester.edu
Phone:      (585) 275-1158
Fax:          (585) 276-0149
Mail:         University Health Service
                 Attn: UHS Medical Record Request
                 Box 270617
                 Rochester, New York 14627

PLEASE NOTE: For the release of medical records from the University of Rochester Medical Center (URMC) or Strong Memorial Hospital, call 585-275-2605 (Strong Health Information Management).