Due to public health concerns, the Health Information Management Department is closing the office to the public to eliminate person to person contact. We understand your medical records are important to you and want to make this process as smooth as we can during this time.
To expedite your request, please complete the medical record request in its entirety. If you have questions on how to complete the request, contact our Health Information Department at 215-487-4295.
Health Information and Medical Records
Photocopies of your records are available upon request and shall be released only with an appropriate patient authorization and/or in accordance with applicable state and federal laws. This is for compliance with all federal and state laws, and the purpose is to safeguard your confidentiality. You may be contacted by a Release of Information Specialist concerning this request. In order to process your request expeditiously, the following information needs to be included:
- Patient Name
- Date of Birth
- Date(s) of Service
- Information needed
- Purpose of the request
- Name of individual authorized to receive the information
- Signature of patient, legal guardian or individual authorized by law to release medical records on behalf of the patient
- Please include a phone number where we can reach you in case there are questions about your request.
Please note, if you are aware of any protected information (i.e.. Psychiatric, Psychological, Drug abuse, alcoholism or HIV infections, you will have to fill out a special authorization which can be obtained by calling Release of Information Representative at 215-487-4295.
Ways I can I request my Medical Records?
- Mail in Requests
- Fax Medical records Request
Where can I send my Medical Records Requests?
You may submit the request by mail to:
Attn: Medical Records/ROI
5800 Ridge Avenue
Philadelphia PA 19128
You may also fax the request to: 215-487-4213
You may use the link provided to print a copy of the Auth-Release-PHI-form. Please complete the form in its entirety and fax the form to the secured Health Information fax at 215-487-4213.
What if I am requesting for my Physician and upcoming appointment for continuity of care?
Please have your physician fax request to 215-487-4213 In addition, please note the date needed or appointment date so the request could be expedited. Please ensure you PRINT the Physician’s Name clearly and visibly.
When will I / the Third Party receive a copy of my medical record?
Medical record requests are processed within 15 business days from the date the request is received by Roxborough Hospital.
You can also call the Release of Information Department for additional information regarding obtaining copies: 215-487-4295.