For questions or technical assistance regarding submission of medical record requests, please contact 1-888-790-2133. Technical assistance is available Monday through Friday (except federal government holidays) 7 am to 5 pm (EST).
Medical Records Request
Health Information Management Department
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 Department uses an NIH approved secure file sharing service, BOX, to allow for electronic submission of completed Authorization for Release of Information Forms.
NOTE: Hand-written or electronic signature is required in order for your request to be processed. 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 Department 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 Department at 1-888-790-2133 or review the BOX website. (Privacy notice for BOX website)
NOTE: PDF documents require the free Adobe Reader.
This page last updated on 11/04/2019