How to Request Medical Records 

To request medical records from Orange Regional Medical Center, you will need to submit a written request to the Health Information Management (HIM) Department.

You can either use an Authorization for Release of Protected Health Information (PHI) form or you may submit a letter to the HIM Department. (See Writing a Letter to Request Medical Records below). 

To request medical records from Orange Regional Medical Center, you will need to submit a written request to the Health Information Management (HIM) Department. This letter must include the following information:

1. Identifying information (your name, date of birth, medical record number (if known)
1. The name and address of the individual or institution you wish to receive your records
2. The specific information you would like released; you must also include a time frame (example: April 12, 2006 or April 2006 to May 2006) and the type of information (example: Emergency Room Record)
1. Signature of the patient or legal guardian and date (Please note: if you are submitting a request on behalf of an adult for whom you are the executor or the power of attorney, you must submit a copy of the appropriate documentation)
2. An expiration date for the request. If no date is given, the authorization will expire 1 year after being signed
3. A statement that the authorization may be revoked at any time, except to the extent that action has already been taken in reliance on the authorization
   
4. Address your letter to location at which you received care (see mailing addresses below)

Medical record requests are usually processed within seven to ten business days.

A photo ID is required when picking up requested information.

Fees

If the information to be released is sent to a physician, hospital or medical provider, there will be no charge for the records. For records sent anywhere else (to yourself, attorney, etc.) there will be a fee assessed based on the number of pages copied. The fee is $.75 cents per page.

Mailing Addresses


Orange Regional Medical Center Horton Campus
Health Information Management Department
60 Prospect Ave.
Middletown, NY 10940

Orange Regional Medical Center Arden Hill Campus
Health Information Management Department
4 Harriman Drive
Goshen, NY 10924


Office Locations

Orange Regional Medical Center Horton Campus
Health Information Management Department
Ground Floor
845-342-7565

Orange Regional Medical Center Arden Hill Campus
Health Information Management Department
1st Floor
845-294-2133

Download the Authorization for Release of Protected Health Information Form (PDF)