NHH Medical Records Requests

Monday – Friday, excluding State holidays, from 8 AM to 4:00 PM

Complete the Disclosure of Patient Information Form. You may also contact us at the above phone number and we will mail or fax one to you. We can also send you a form by e-mail. Once you have completed, signed and dated the form you may mail, fax or e-mail it to our office using the address, fax or e-mail information listed above.

New Hampshire Hospital
Health Information Department
121 Fruit Street
Concord, NH 03301

Generally, no, but there are some exceptions. You will need to bring written documentation if:

• You have written authorization from the patient;
• You are the patient's legal guardian;
• You are the court appointed legal representative for the patient;
• The patient is under 18 and you are the parent or legal guardian;
• The patient is deceased and you are the administrator of the estate,
• The patient is deceased, has no estate administrator and you are the current surviving spouse.

Your privacy is important to us. Your written request is another way to ensure that you are the person who has requested the information and that it will be sent to you at the correct address.

You may send us a letter requesting the copies. Please include your name, date of birth, any other names you may have used (such as maiden name or other married names). Please be specific with the dates of information and reports you wish disclosed and be sure to sign and date the letter. There may be a fee for this service.

We must comply with Federal and State regulations that protect the privacy of your health information. It is unlawful to disclose information without your written authorization. There are certain records protected by special laws. Psychiatric records, substance abuse records or records that indicate HIV status require specific authorization from you.

• If you were recently admitted to the hospital and signed an authorization to send information to your care providers, we will send the information once the record is complete.
• If you were admitted longer than a year ago or if you have other providers to whom you wish to send copies of your record, please complete the New Hampshire Hospital Authorization to Disclose Protected Health Information and return it to the Health Information Department.

If you are the administrator of the estate you may have copies. If the records are of your spouse and your spouse had no will, you may have access to the records, otherwise the administrator of the estate must authorize the disclosure to you. Please contact the Health Information Department (603-271-5300) to discuss the additional documentation we will require from you to obtain a deceased family member's medical record.

Requests for genealogy information should be directed to NH Vital Records Genealogy Vault (603) 271-4650.

Call us and let us know that you want to cancel the request. We will hold the request until we receive a written statement from you that you wish to withdraw the request. Upon receipt we will be able to stop any further disclosure. We are unable to retrieve the information sent prior to your written revocation based on your signed authorization.

We limit the information sent to the minimum necessary for the purpose stated on the request. You must specify on the authorization form the specific information to be disclosed.

You should ask the receiver of your information how it is used and stored.

Once your child becomes 18 years old and you are no longer their legal guardian, your child is considered an adult. He or she must authorize the disclosure of the information regardless of their age when a patient at New Hampshire Hospital.

We make every effort to send the information within 10-12 working days. If you have an upcoming appointment with your care provider, please let us know the date and we will make every attempt to have the records arrive in time for your appointment. If you were recently discharged it may take longer to comply with the request since we need to make sure all the information in your record has been completed before sending it. It may take up to 15-20 working days after your discharge date.

Please call us at (603) 271-5300 or e-mail at MedicalRecordRequests@dhhs.nh.gov.
Our customer service staff can assist you.