How to Request Medical Records
To request medical records from Orange Regional Medical Center, you will need to submit a written request to the Health Information Management (HIM) Department.
Orange Regional has achieved the Stage 7 Level designation from the Healthcare Information and Management Systems Society (HIMSS) for implementing technology solutions (EPIC) that have the ability to improve patient safety and quality of care.
You can either use an Authorization for Release of Protected Health Information (PHI) form or you may submit a letter to the HIM Depart ment. (See Writing a Letter to Request Medical Records below).
Writing a Letter to Request Medical Records
To request medical records from Orange Regional Medical Center, you will need to submit a written request to the Health Information Management (HIM) Department. This letter must include the following information:
- Identifying information (your name, date of birth, medical record number (if known)
- The name and address of the individual or institution you wish to receive your records
- The specific information you would like released; you must also include a time frame (example: April 12, 2006 or April 2006 to May 2006) and the type of information (example: Emergency Room Record)
- Signature of the patient or legal guardian and date (Please note: if you are submitting a request on behalf of an adult for whom you are the executor or the power of attorney, you must submit a copy of the appropriate documentation)
- An expiration date for the request. If no date is given, the authorization will expire 1 year after being signed
- A statement that the authorization may be revoked at any time, except to the extent that action has already been taken in reliance on the authorization
- Address your letter to location at which you received care (see mailing addresses below)
Medical record requests are usually processed within seven to ten business days.
A photo ID is required when picking up requested information.
- An HIM employee is available in Booth 7 of the Registration area to help you with any questions that you may have. Hours are Monday – Friday, 9am to 5pm.
There is no charge to obtain a copy of your medical record.
If you have a MyChart account, your records can be released to MyChart. Please make sure to state this on your request.
If you do not have a MyChart account and would like to sign up for this, please download the MyChart Activation Form and return it to the address below.
Orange Regional Medical Center
Health Information Management Department
707 East Main Street
Middletown, NY 10940
Download the Authorization for Release of Protected Health Information Form(PDF)