Your Medical Record >>

At The Medical Center, we respect your privacy. If you would like us to forward a copy of your medical record to a health care provider, we need your written authorization, which is valid for six months, and a legible copy of your valid photo identification. If you pick up your medical record in person, a photo ID is sufficient. Also, please provide a range of dates of service, or information that identifies the information you need - for example, "all records from 2000 to present date" or "anything pertaining to my broken leg."

The cost to obtain copies of your medical record is fifty cents per page. If we are sending the records directly to a healthcare provider for you they are free. Payments for copies can be made by cash or check only.

Please print the Authorization to Release Protected Health Information (Medical Records) form, complete it and mail to:

Correspondence Coordinator, Health Information Services
Southern New Hampshire Medical Center
PO Box 2014
Nashua, NH 03061

or fax to: (603) 577-5633.

For more information, please call the Correspondence Coordinator at (603) 577-2342.