Medical Records Requests

Check the box for the entity (also called clinic or location) where you received care. By checking the box, you are requesting to have your medical records released from that location.

If you select UMass Memorial Medical Group, Harrington Physicians or Milford Regional Provider Group, please enter your physician’s name and location on the line below.

Fill out the patient information. You are not required to provide the medical record number, but if you have that information, please enter it on the form.

Select who you would like the medical records to be released to and fill out where you would like the records to be sent.

Specify why you are requesting medical records by checking the appropriate box next to the purpose of your request. Please note that if you are a health care proxy (HCP), you may only request medical records on behalf of a patient for continuing care purposes.

Select how much information you would like us to release. You can choose to receive an abstract or the entire medical record for a specific visit or for several visits within a range of dates. 

• Abstract: Abstracts include key elements and the most commonly requested information from a specific visit. If you select to receive an abstract, it will include a list of medications, allergies, lab results, X-rays and other diagnostic tests. Abstracts also include the provider’s report from the visit.
• Entire records: Entire medical records include all the information from a specific visit or from multiple visits during a range of dates.

Please note that there are fees associated with receiving medical records. The fees for the entire medical record are higher than those for an abstract. If you have questions about how much information you need, contact a member of our team.

If you are only requesting records related to specific services or tests (such as lab results, immunization records or imaging reports), please let us know by checking the appropriate box. Make sure to include the date you received services in the space provided.

Some health information is protected under state or federal law. If you are requesting medical records that include protected health information (PHI), you are required to authorize the release of that information by checking the appropriate box. If you do not check the box that relates to the information you’re requesting, we cannot fulfill your request.

There may be fees associated with certain types of requests. Fees are based on state and federal guidelines. We’ll let you know your total once we process your request.

A fee for photocopies may apply per Massachusetts General Law, Chapter 111, Section 70.

Please allow us up to 30 days to process your request.

If you believe information in your medical record is incorrect, please complete the Request to Amend Protected Health Information form.

If you are someone’s HCP and you are requesting their medical records, please note that the patient’s health care provider must invoke (or activate) the HCP. The provider must document that the patient is unable to make their own medical decisions and confirm in writing that the HCP can now make those decisions. As an HCP, you can only request medical records for continuing care purposes.

To request medical records as an HCP, please complete the medical records request form.

If you are requesting an autopsy or medical records for a deceased patient, you need to submit a written authorization. You also need to submit one of these legal documents, which you can obtain through the probate court:

• Proof that you have been appointed executor of the estate, along with a Letter of Authority for Personal Representative
• Proof that you have been appointed a voluntary administrator, along with an attested copy of a Voluntary Administration Statement
   

Contact our Billing department at 508-334-1840.

Contact the radiology department of the facility where the services were provided:

• Harrington: 508-765-3030
• HealthAlliance-Clinton: 978-466-2689
• Marlborough Campus: 508-486-5600
• Memorial Campus: 508-334-6131
• Milford Regional: 508-422-2922
• University Campus: 774-441-8406
   

As the largest health care system in Central Massachusetts and beyond, UMass Memorial is made up of several hospitals, including a children’s medical center, behavioral health services and a dedicated provider group. 

• UMass Memorial Medical Center (University, Memorial, Marlborough campuses)
• UMass Memorial Health – Harrington Hospital (Southbridge)
• UMass Memorial Health – HealthAlliance-Clinton Hospital (Fitchburg, Clinton and Leominster)
• UMass Memorial Health – Milford Regional (Milford)
• Community Healthlink (Worcester)