Medical Records

Your Rights Regarding Your Medical Records

The federal privacy regulations give you many rights regarding your medical records. They include:

• The right to an accounting of certain disclosures of your medical information in the six years prior to the date of your request.
• The right to inspect and obtain a copy of your medical information.
• The right to receive confidential communications of your medical information by an alternative location.
• The right to request an amendment to your medical record.
• The right to submit a complaint to this hospital about how your medical information is used or disclosed.

Please print and complete the appropriate authorization form linked below. Fax, mail, e-mail or deliver the completed form to the hospital or facility where you received service. For other questions about medical records, call the phone number below at the location where you received service.

For a patient or designated personal representative to request a copy of medical records:

Medical records request — english

Solicitud de registros médicos — español

To authorize Asante to release a copy of records to someone other than you or your personal representative:

Authorization to Release/Disclose Protected Health Information — English/Spanish

Medical Records E-mail Address: ROI@asante.org