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Request copies of your health information

Request copies of your health information

You must submit written permission before we can release your child's health information. Use the form below to make sure we know what information you want us to release and to whom we can release it.

Release form

Authorization for the Release of Medical Record Information

Adobe Acrobat Reader is required to open this form. Click here to download Acrobat Reader. If you cannot download the form, call 617-355-7546, and we will mail a copy to you.

Note: To request materials that contain sensitive, legally protected information, such as HIV test results, a different request form must be signed and submitted. Please call 617-355-7546 for more information.

Release of X-rays or other radiological images

Please contact the Department of Radiology Film Library at 617-355-6283.

Authorization for Release of Radiology Images form

How to submit your request form

Mail or fax your completed and signed authorization form to the address or fax listed on the form. You may also drop off form(s) in the Medical Records Department during business hours: Monday through Friday, 8 a.m. to 4:30 p.m.

We are located in the Fegan Basement, Rm B-014, 300 Longwood Avenue, Boston MA 02115.

Receiving the information you requested

Due to the large volume of requests, record copies are not immediately available. Once the Medical Records Department receives your authorization to release information, it will take approximately 10 business days for the record to be photocopied and mailed.

The information will be mailed as soon as it is available to the address you provide.

Note: Please bring a photo ID if you choose to pick up record copies at Children's.


					Children's Hospital Boston is the primary pediatric teaching hospital of Harvard Medical School

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