Request Medical Records

Patients treated at the Hospital for Special Care may request a copy of their medical records by faxing or mailing the completed, signed Authorization to Release Patient Health Information form, following the instructions below.

Get Acrobat Reader

Adobe Acrobat Reader is needed to download and print the form.

Completing the Authorization to Release Patient Health Information Form

Specify what information you want sent from the medical record. Please be as specific as possible. Be sure to include the patient’s:

  • Full Name
  • Date of Birth
  • Current Address
  • Current Telephone Number
  • Dates of Service
  • Signature / Date /Print Name

Applicable Fees

If copies are going directly to a physician or hospital, there is no charge. If copies of the medical records are to be sent directly to you, there is a fee of 65 cents per page. You will receive a bill from HealthPort for your copies.

Submitting the Request Form

Fax or mail to:

860.827.4837
Release of Information – HIM Department
Hospital for Special Care
2150 Corbin Avenue
New Britain, CT 06053

 

For questions, call: 860.827.4863(Monday – Friday, 8 am-4 pm)