(English I Spanish), Bradley Hospital  Questions? Authorization for Use or Disclosure of Health Information form, Lifespan Physician Group, Inc  Contact Info. 301 N. Washington Ave., Dallas, TX 75246 |. Please submit the form via email, fax to (313) 916-3917 email HFHSMedicalRecords@hfhs.org . To help ease this transition, please review these forms. There is a fee to copy medical records unless records are being requested for continuity of care. Requesting your Medical Records UPMC Content 2 At UPMC Magee-Womens Hospital , we are committed to protecting the privacy of your medical information — health, treatment, or payment information that identifies you — as federal and state laws require. A copy of your medical records may be obtained by downloading and printing the form below and bringing it to your doctor's office, Butler Hospital's medical records office in the basement level of the Center House Building or by mail. However, there are minimal fees (per page) for obtaining medical records for other purposes. Submit form by: Mail: MLHC - Medical Records, PO Box 40628 Memphis, TN 38174. © 2020 Baylor Scott & White Health. AddressBaylor Scott & White Medical Center – College Station Health Information Management Department 700 Scott & White Drive College Station, TX 77845 Fax979.207.2171 Phone979.207.2163, AddressBaylor Scott & White Medical Center – GrapevineHealth Information Management Department – Release of Information 1650 W. College St. Grapevine, TX 76051 Phone817.329.2543 Fax817.329.2883, AddressBaylor Scott & White Medical Center – HillcrestHealth Information Management Department 100 Hillcrest Medical Blvd. If you are requesting records be sent to you, you will receive a bill Mail the completed authorization form to: Ascension Providence Hospital, Southfield Campus Health Information Management Dept. 401-793-7967 Deliver this form to: Hours: Monday – Friday, 8 a.m. – 5 p.m. Closed on holidays. Providers should fax the medical request form to 301-618-2997. We are able to accept and honor fax requests from a medical provider on behalf of any patient as part of our commitment to continuity of care. Fax: Only accept fax from Patients and Healthcare Requestors Patients requesting records fax to : 901-937-6688 Information from all of your Lifespan health care providers is available in that record. Highland Hospital Health Information Management Release of Information 1000 South Ave, Box 55 Rochester, NY 14620 Phone: (585) 341-6766 We encourage patients to request medical record information at least 10 days prior to any follow-up care. Get your records efficiently and securely faster than ever. protect your privacy or the privacy of your loved one, proper identification will be required to obtain medical records. You can request copies of your medical records by visiting our Health Information Management office on the main level of the hospital. Fill out the information on the form, indicating the records you are requesting and the specific date of your visit. Medical Records. 401-667-6557 Phone: 816.792.7067 Fax: 816.792.7114. Yes, there is a charge to copy records for your own personal use. If you are a physician or hospital and your request is emergent please fax your request to (310) 206-4831. The signed form can either be hand delivered or mailed to the address below or sent via fax to the fax number below: Rush Copley Medical Center Medical Records Department (lower level of hospital) 2000 Ogden Ave., Aurora, IL 60504 To request your medical records, please visit our Health Information Management department on the first floor of the hospital between the hours of 9:00 a.m. – 5:00 p.m., Monday through Friday. save time and money with the national center for medical records. The physician's office can fax the request to 202-715-4361. Lifespan Corporate Offices If you have any questions, please contact the appropriate hospital at the number listed below. Medical Records Phone Numbers: Rhode Island Hospital and its Hasbro Children's Hospital 401-444-4040 Authorization for Use of Protected Health Care Information form (English | Spanish) The Miriam Hospital 401-793-2220 Authorization for Use of Protected Health Information form (English I Spanish) Bradley Hospital 401-432-1340 Moving, changing jobs, or experiencing a major life event and need a quick and easy way to get medical records? Stanford Health Care medical records. Sharon Regional Medical Center Attn: Release of Information 740 East State Street Sharon, PA 16146. 1131 Option 1 Fax972.412.3360, AddressBaylor Scott & White Medical Center – Lakeway Health Information Management Department 100 Medical Parkway Lakeway, TX 78343 Phone512.654.5173 Fax512.654.5421, AddressBaylor Scott & White Medical Center – Llano Health Information Management Department 200 W. Olive St. Llano, TX 78643 Phone325.247.7871 Fax830.201.8657, AddressBaylor Scott & White Medical Center – Marble Falls Health Information Management Department 810 W. Highway 71 Marble Falls, TX 78654 Phone830.201.8651 Fax830.201.8657, AddressBaylor Scott & White Medical Center – McKinneyHealth Information Management Department 5252 W. University Drive McKinney, TX 75071 Phone469.764.2300 Fax469.764.2313, AddressBaylor Scott & White Medical Center – PflugervilleHealth Information Management Department2600 E Pflugerville Parkway, Suite 100Pflugerville, TX 78660 Phone512.654.6292 Fax512.654.6281, AddressBaylor Scott & White Medical Center – PlanoHealth Information Management Department 4700 Alliance Blvd. MyLifespan is your window into your electronic health record. 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