The Health Information Management Department at WMC maintains documentation of each patient's medical care. It is the obligation of WMC to protect the confidentiality of the patient's medical record. Any information contained in the medical record is confidential and protected by federal and state law. Therefore, patient information may only be released upon receipt of an appropriate patient authorization, valid subpoena or court order.
Patients will be furnished with a copy of their record upon receipt of a written request or a completed WMC Authorization to Disclose Protected Health Information Form. For continued patient care directly to a physician's office or other healthcare facility, WMC will request a written authorization by the patient. In the event of an emergency whereas the patient is unable to sign, WMC with require a signed authorization from the physician responsible for treating the patient.
Retention
Medical records are maintained according to NY State Laws and hospital policy. Adult medical records are maintained for 10 years after the last visit. Pediatric records are maintained until the patient is 21.
Minors
Parents of minors (under 18 years of age), next of kin or legally appointed guardians, may obtain a copy of a minor's record upon receipt of a written request or a completed WMC Authorization to Disclose Protected Health Information Form. If a minor was treated for sexually transmitted disease, birth control treatment, drug/alcohol abuse treatment, HIV or mental illness, the records can only be released upon the minor's authorization.
Deceased Patients
The records of a deceased patient may be obtained by a qualified person or personal representative upon receipt of a written request or a completed WMC Authorization to Disclose Protected Health Information form. Where an estate is being probated, the records can be released upon receipt of a copy of the letter of estate administration or letters of testamentary and a certified death certificate. Questions regarding the release of deceased patient records in the absence of these documents should be referred to the Health Information Management Department.
Requesting Copies of Medical Records
To request your medical record in person or by mail/fax, a copy of a photo ID is required, and you will need to fill out a "WMC Authorization to Disclose Protected Health Information" form. Records can be provided electronically via CD, flash drive, or sent to you by email. Please specify on the authorization if records are preferred in either of these formats. Below are links to the forms in both English and Spanish. This Authorization Form and the photo identification can be faxed to: 914.493.1569. The authorization can also be mailed to:
Westchester Medical Center
Attn: Health Information Management
100 Woods Road
Valhalla, NY 10595
Phone: 914.493.7600
Authorization for Release - English
Authorization for Release - Spanish
Authorization for Psychotherapy Notes Release
Frequently Asked Questions
How do I get a copy of my medical records?
To get a copy of your medical records, you must complete an authorization form. You may access the form via this page or obtain a copy from our office.
Do I have to sign the authorization?
Yes. The authorization form must be signed by the patient. Signatures other than the patient's must have documentation of authority to sign along with a valid state ID.
Do I have to pay for copies?
Yes. New York State Public Health Law allows WMC to charge a reasonable fee to recover the costs of copying, mailing and supplies used to fulfill your request. Patients will receive a pre-bill or a payment notice with their records (a significant discount is applied if electronic copies are requested). However, there is no fee if the record is being released to a doctor or healthcare provider for continuity of care.
How long will it take to receive my records?
Authorizations are processed within 5 to 10 business days of receipt. All records are mailed via US mail so please allow time for delivery.
Can someone else pick up my medical records?
Yes, as long as you specify on the signed authorization the name of the person you would like to pick up the medical records. The person picking up the medical records must show a valid ID at time of pick-up.
How do I get a copy of Birth/Death Certificates?
We do not maintain these documents. Please contact the Town Clerk in the Town of Mount Pleasant at 914.742.2312
Medical Records Request Form
The Health Information Management Services (HIMS)
The Health Information Management Services Department is responsible for organization, storage and retrieval of patient records.
You may call our correspondence secretary at 845.368.5323 or 845.368.5000 ext. 6254, Monday through Friday 8 am to 4 pm, or fax an authorization to 845.368.5346 for copies of your records. You will be required to sign an authorization before the records will be released. Identification is required.
- In the case of a mental or incompetent patient, or the death of an adult, the executor or administrator of the estate or the guardian of the incompetent who presents proper credentials from court signs the authorization for release of privileged information. If there is no such fiduciary appointed, then the next of kin may sign the authorization.
- Minors, as defined by New York State, are individuals under the age of 18. A parent or legal guardian must authorize the release of privileged information on the record of a minor. Emancipated minors may sign for release of their own information. An emancipated minor is any person under the age of 21 who is living apart from his/her parents and makes his/her own living, or a minor who is married.
If the records are for your own use, there is a charge of $0.36 per page. You will be sent a pre-bill from our copy service company (845.368.5000 ext. 6254) for the copying of records.
If you are writing or faxing an authorization, please send it to the attention of HIMS correspondence secretary and include the following information:
- Name
- Date of birth
- Phone number
- Date(s) of service
- Where copies are to be sent (name, phone, address)
- Reason for copies
- When copies are needed
- Your signature is required
Response to authorizations will be within 10 days of receipt, as required by NYS law.
Radiology Reports
To obtain records from the Radiology Department, including MRI, CT and other imaging procedures, call 845.368.5000 ext. 6120.
Birth Certificates
The hospital birth registrar (845.368.5000 ext. 6253) compiles the newborn information and forwards this information to the Village of Suffern who issues the birth certificate. The hospital does not have access to birth certificates. Copies of birth certificates can be requested from the Village of Suffern at 845.357.2600 (a charge for the copy may apply)
Authorization for Release of Health Information (Including Alcohol/Drug Treatment and Mental Health Information) and Confidential HIV/AIDS related Information
Bon Secours Community Hospital
HIM Department
160 East Main Street
Port Jervis, NY 12771
Phone: 845.858.7090 | 858.845.7092
Fax: 845.858.7408
Good Samaritan Hospital
HIM Department
255 Lafayette Avenue (Route 59)
Suffern, NY 10901
Phone: 845.368.5323
Fax: 845.368.5346
St. Anthony Community Hospital
HIM Department
15 Maple Avenue
Warwick, NY 10990
Phone: 845.987.5295
Fax: 845.988.9490
Authorization for Release of Health Information (English | Spanish)