Authorization to Release Medical Records

To request a copy of your medical records, print and submit a completed Authorization for Disclosure of Health Information form to the location where you received care.

Outpatient Records

• Outpatient record requests must be submitted to the specific department in which the service was received.
• Radiology films and reports can be obtained from the Film Library for that particular hospital.

Inpatient Records

• Inpatient record requests should be sent to the hospital the patient attended.
• In some instances there may be a cost involved.

Hospital Information

• Hospital of the University of Pennsylvania
  Medical Records Department
  1st Floor Founders
  3400 Spruce Street, Philadelphia, PA 19104
  Phone: 215-662-3154
  Fax: 215-662-6300
• Penn Presbyterian Medical Center
  Medical Records Department
  Myrin Basement
  51 North 39th Street, Philadelphia, PA 19104
  Phone: 215-662-8959
  Fax: 215-243-8758
• Pennsylvania Hospital
  Medical Records Department
  1st Floor Preston
  800 Spruce Street, Philadelphia, PA 19107
  Phone: 215-829-3931
  Fax: 215-829-3027