Need a Copy of Your Medical Records?
Your medical records are considered protected health information, or PHI, and may include, but are not limited to, things such as such as blood test results, medical imaging, physicians’ notes, diagnoses, recommended treatments and prescriptions, and daily chart information. We can help you access them in a couple of ways:
- For your personal use, you can get some records through South Nassau’s patient portal, FollowMyHealth.
- For other records, you can order paper copies, or a CD. Because there is a charge per page, we suggest you only request what is necessary: A $0.36 per-page charge is assessed for copying.
Steps to getting your PHI or medical records:
1. Complete the information release form. Download it here: English or Spanish.
Make sure to include:
- Patient name, address, date of birth, last four digits of the patient's Social Security number and contact number
- Admission/treatment date
- What information should be released
- Address and the name of the individual or organization to receive the information
- Patient signature
2. Bring your photo ID and the completed form in person or mail to the attention of the Correspondence Department:
For medical records from the Emergency Room, or for Inpatient or Ambulatory Surgery, visit South Nassau’s Health Information Management (HIM) Correspondence Department, open weekdays from 9 a.m.-5 p.m.
- For medical records from outpatient care or from one of our off-site facilities, contact the facility where you received care
- Requests from attorneys, insurance companies, private physician offices and any other non-patient care requests are handled during South Nassau’s Health Information Management (HIM) business office hours, weekdays from 9 a.m.- 5 p.m.
We process all requests through Clinical Data Exchange (CIOX Health) Department. Please allow 7-10 business days for processing, which is the time frame approved by state law.
Who Is Authorized to Request Medical Records?
- Any adult age 18 or over, or an emancipated minor.
- Qualified persons of a deceased patient.
- If you are the appointed administrator or executor, bring a certified copy of the administrator estate paper
- If an administrator or executor has not been appointed, bring a certified copy of the patient's death certificate as well as the signed confirmation of the distributee status form
- An attorney or an individual who holds power of attorney. Bring a copy of the power of attorney that specifically authorizes the attorney to make a written request for patient information.
- For a deceased patient, the distributee's (or heir’s) attorney. The requestor must provide a certified copy of the death certificate, as well as a copy of the power of attorney specifically authorizing the attorney to make a written request for patient information.
To File a Voluntary Acknowledgment of Paternity
A voluntary Acknowledgment of Paternity is a legal document that both parents sign, if they choose to. It names the father of the baby when the parents are not married to each other. The Acknowledgment of Paternity form must be completed at the hospital.
Before signing, please review the information from the New York State Department of Health, called "Notice Regarding Your Legal Rights and the Consequences of Signing an Acknowledgment of Paternity": Download a PDF in English or in Spanish.
If you have any questions about this document, contact the Child Support Collection Unit of your county's Department of Social Services. If you have questions regarding the form as it relates to the birth certificate process, contact the local birth registrar where the acknowledgment will be filed.
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