How to Request a Copy of Your Medical Records
To request a copy of your NIH Clinical Center records, you will need to complete our Authorization for Release of Information form (Para Español Autorización para la Divulgación de Información Médica).
If you have any questions about how to complete the form or any questions about the release process, please call us at 888-790-2133.
This form can be mailed, faxed, or submitted electronically using the below instructions:
The Health Information Management Division (HIMD) uses an NIH approved secure file sharing service, BOX, to allow for electronic submission of completed Authorization for Release of Information Forms.
NOTE: Authorization forms must include a manual/handwritten signature using paper and pen or a manual/handwritten signature on an electronic device using a mouse, stylus, finger, etc. Typed signatures or digital signatures enabled by certificates will not be accepted.
If the patient is 18 years of age or older, the patient is the only person who is permitted to sign this form. If the patient is under the age of 18, the parent or guardian must sign this form.
There are situations in which this general rule does not apply. For consultation regarding who is authorized to sign this form, contact the Health Information Management Division at 1-888-790-2133.
Drag and drop your file into the box above or select browse your device to choose your file.
In the File Description text box, type in your full legal name, date of birth, and any other information you would like to convey with the form (Optional).
Enter your e-mail address (Required).
Select the Upload button once.
You will receive the following message on-screen after the upload has been successful:
Success. Your file has been uploaded, and the owner has been notified.
BOX is a secure commercial site approved by NIH which provides an easy and fast method for sending and receiving large files. For additional details, please contact the Health Information Management Division at 1-888-790-2133 or review the BOX website.
Purposes and Use of Information We Collect from You
This Privacy Notice explains the collection and use of Personally Identifiable Information (PII) about you through the CC HIMD Website. The BOX application presents a form and asks for your name, your e-mail and an open text message. The information collected reflects the minimum necessary to accomplish the purpose of uploading the signed Authorization for the Release of Medical Information form, and other patient completed authorization forms (patient portal consents, etc.) to the CC Health Information Management Department.
By using the third-party BOX Website to send signed document(s) to the NIH CC Health Information Management Department, you may be providing nongovernmental third-parties with access to PII and/or sensitive information. Please note that by voluntarily providing your information and uploading documents into this site, you are accepting the practices described in this Privacy Notice and consent to the collection, storage, and use of personal information about you as described in this Notice. Use of this service is optional. If you do not wish to use this service, but still wish to send the signed document, you may mail the document to CC Health Information Management Department, 10 Center Drive, Room B1L400, MSC 1192 Bethesda, MD 20892 or fax to 301-480-9982.
Security of Information
At all times, security maintenance and administration is an important part of website operations and maintenance. BOX maintains approved physical, electronic and procedural safeguards to comply with federally approved standards to guard your nonpublic personal information. The system uses appropriate administrative, technical and physical controls for protection of information contained therein and is protected by multiple firewalls, vulnerability scanning, and advanced encryption technology. Access to your information requires entry of a personalized username and password by CC HIMD staff. In non-routine circumstances, system administrators at BOX may have incidental exposure to your information during unexpected events such as data recovery.
If you have any questions or concerns regarding this Privacy Notice, please call the CC Health Information Management Department (HIMD) at 1-888-790-2133.