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Obtain Medical Records

Request Medical Records from Bon Secours Community Hospital

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 Medical Records Request Form

Authorization for Release of Health Information (Including Alcohol/Drug Treatment and Mental Health Information) and Confidential HIV/AIDS related Information

Authorization for Release of Health Information (Including Alcohol/Drug Treatment and Mental Health Information) and Confidential HIV/AIDS related Information

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