To request that a copy of your/your child's medical record be released to you or to an organization (i.e., school, day care provider, employer), complete a request form (see table below) and send it by mail or fax or deliver it in person to the Children's Hospital location indicated below. Because a signature is required to release your information, we are not able to process requests received by telephone or email. If you pick up a copy of the medical record in person, we will ask for photo identification. There may be a fee for providing copies of the medical record.
| To request information about: | Use this form and send to the location indicated below: |
|---|---|
| Inpatient services provided at the Main Hospital or Children's Seashore House, including Emergency Department visits, day surgery, and stays lasting 23 hours or longer | Authorization to Release/Obtain Patient Information Health Information Management Department The Children's Hospital of Philadelphia 34th and Civic Center Boulevard Level A, Room AW80 Philadelphia, PA 19104 Telephone: 215-590-3640 Fax: 215-590-4193 |
| Outpatient services (i.e., doctor visits, blood tests) provided at the Main Hospital* | Authorization to Release/Obtain Patient Information Send to the department where service was provided or call 215-590-1000 to reach the appropriate department. |
| Outpatient services (i.e., occupational or physical therapy, speech, rehabilitation, psychology) provided at Children's Seashore House | Authorization to Release/Obtain Patient Information Health Information Management Department The Children's Hospital of Philadelphia 34th and Civic Center Boulevard Level A, Room AW80 Philadelphia, PA 19104 Telephone: 215-590-3640 Fax: 215-590-4193 |
| Services provided at Pediatric and Adolescent Specialty Care Centers | Authorization to Release/Obtain Patient Information Send to the Specialty Care Center where service was provided. |
| Services provided at Pediatric and Adolescent Care Centers | Authorization to Release/Obtain Patient Information Send to the Care Center where service was provided. |
| X-rays or other radiological images, including CT scans, MRIs and ultrasounds. (Radiological images are released on CD.) | Authorization to Release/Obtain Patient Information The Children's Hospital of Philadelphia Radiology Department Radiology File Room 34th and Civic Center Boulevard Philadelphia, PA 19104 Telephone: 215-590-1000 Fax: 215-590-4783 |
*If a test was ordered by a physician who is not affiliated with Children's Hospital, please contact that physician directly.