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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 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 medical record sent TO Dartmouth-Hitchcock

To authorize others to view and manage your medical records

To revoke permission for others to view or share your medical records

To request changes to your medical records

To consent to medical treatment of a minor child

To request a copy of a decedent's medical record or autopsy report

Under New Hampshire law, a decedent's medical information may be released either directly to the decedent's surviving spouse or next of kin, in certain circumstances, or by authorization from the Administrator or Executor of the decedent's estate. To request that a copy of a decedent's records or autopsy report be mailed to you:

Related pages

Manage your health care with myD-H!

Communicate securely with your health care providers, request or change appointments, request prescription renewals, view your account and make payments online, review your medical record, and more. Learn more about myD-H.

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