We respect and treat your privacy seriously when handling confidential patient medical information. Our Notice of Privacy Practices describes how medical information about you may be used and disclosed, and how you can request access to your records.
Requesting Medical Records
If you were treated at Hospital for Special Care you may request a copy of your medical records by sending a completed and signed authorization for release of information form to the Health Information Management department:
*Email is not a secured form of communication and may pose a risk for confidentiality
Mail to: Release of Information – HIM Department
Hospital for Special Care
2150 Corbin Avenue
New Britain, CT 06053
Your records can be released to anyone you authorize in writing to receive such information. The authorization for release of information must include the following:
- Patient’s Full Name (including maiden name or other names that may be needed to locate the correct record)
- Date of Birth
- Dates of Service
- Patient’s Current Address
- Telephone Number where you can be reached with questions
- Signature, Date and Printed Name of the patient or other authorized person making the request
Authorizations signed by a representative must be verified. Please include a copy of one of the following documents indicating:
- Legal guardianship
- Advanced Directive/Healthcare power of attorney
- Designation of Personal Representative Form to act on patients behalf with regard to personal information
Requests to Send Information to another Provider
Pertinent information is routinely released to other healthcare providers free of charge. Documents will be mailed or faxed directly to the physician or facility. Requests for emergency treatment will be accepted by phone from physicians and facilities treating the patient and faxed urgently.
Requesting an Amendment
If you identify incorrect information in your medical record, please submit a completed amend health information form. Please be sure to include your current address.
A reasonable fee may be charged for requests other than patient directed requests or requests for copies to the patient. If a fee is charged, you may receive a bill from CIOX Health. (CIOX Health is a national vendor that processes requests for records on behalf of the Hospital for Special Care.)