医疗记录 & 发布形式

We keep a private, secure medical record about your health.

您可以:


We take every precaution to keep these records secure and in order. 我们的 Notice of Privacy Practices explains the ways we may use or disclose (release) your medical records. 十大网赌平台推荐 if you have any questions.

请注意: 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 patients at 所有 十大网赌平台推荐卫生 locations 除了Mt。. Ascutney Hospital and 健康 Center and Southwestern Vermont 健康 Care.

To have your medical records sent TO us

To have your records sent to us from another provider or facility, please fill out the following form and give it to the provider or facility who will be sending the record.

View detailed instructions on how to use the form (PDF)

请注意 that the sending healthcare provider's office may have additional requirements for authorizing records to be released to 十大网赌平台推荐卫生.

To authorize others to view and manage your medical records

Please fill out one of the following forms and mail or return it to us:

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

To revoke CareEverywhere consent, Designation of Personal Representative, or Permission to Share Patient 健康 Information, please fill out the following form and mail or return it to us:

To request changes to your medical records

Please fill out the following form and mail or return it to us.

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

根据新罕布什尔州的法律, a decedent's medical information may be released either directly to the decedent's surviving spouse or next of kin, 在某些情况下, 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:

To have copies of your medical record sent FROM us to someone else

To have your records sent to another healthcare provider or facility, please fill out the following form and mail or return it to us.

View detailed instructions on how to use the form (PDF).

Manage your healthcare with myDH!

  • Communicate securely with your health care providers
  • Schedule, request, or change appointments
  • Request prescription renewals
  • View your account and make payments online
  • Review your medical record and more

Create or sign in to your myDH account.