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Medical Records & Release Forms

Dartmouth-Hitchcock keeps a private, secure medical record about your health.

You can:

  • Review the information in your medical records.
  • Request a copy of your medical records. This often involves a fee.
  • Request that your medical records be released to someone else.

We take every precaution to keep these records secure and in order. Our Notice of Privacy Practices (PDF) explains the ways we may use or disclose (release) your medical records.

Contact us if you have any questions.

Note: To protect the confidentiality of our patients, we can only fax medical records in extreme emergencies. Please plan ahead to leave enough time for records to be mailed.

The forms on this page are for Dartmouth-Hitchcock patients at all locations.

To Have Copies of Your Medical Record Sent FROM Dartmouth-Hitchcock to Someone Else

  • To have your records sent to another healthcare provider or facility, please fill out our Authorization for Disclosure Form (PDF) and mail or return it to Dartmouth-Hitchcock.

To Authorize Others to View and Manage Your Medical Records

To Request Changes to Your Medical Records

To Consent to Medical Treatment of a Minor Child

Related pages

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