To request medical records from Bon Secours Community Hospital you will need to submit a signed Authorization for Release of Patient Health Information form to the Health Information Management (HIM) Department.
You can download the Authorization for Release of Patient Health Information form below and submit this authorization to the HIM Department.
Medical Record requests are usually processed within 7-10 business days.
A photo ID is required when picking up your requested information.
Fees
If the information to be released is sent to a physician, hospital or other medical provider, there will be no charge for the records. For records sent elsewhere (ex. for yourself, attorney, etc.) there will be a fee of $.36 cents for each page copied.
Mailing Address Bon Secours Community Hospital
HIM Department
160 East Main Street
Port Jervis, NY 12771
P: 845-858-7092
F: 845-858-7408
HIM Department Business Hours: Mon – Friday 7:00 a.m. – 4:00 p.m.
Download the Authorization for Release of Patient Health Information Form