Medical Records

Request for Medical Records
Request for Amendment in Medical Record

Request for Medical Records

Health Information Management (HIM) can provide you with *copies of your medical records related to care and treatment at Newton-Wellesley Hospital.  

*HIM does not provide radiology films or copies of hospital bills. For radiology films, contact 617-243-6071 (choose option #2). For copies of hospital bills, contact 617-243-6100.

How To Receive Your Copy

To receive copies of your medical record, you must submit a written, signed and dated request form.

• Request for Medical Records (pdf)
• Autorización Para Expedir/Recibir Información Médica Protegida (pdf)

Please include:

• Patient’s full name (include maiden name if applicable)
• Address and telephone number
• Date of birth
• Social Security Number (optional)
• Hospital Medical Record Number (if available)
• Date of Service
• Physician Name
• Complete mailing address to send copies

Cost

If you are requesting copies for purposes of continued care, please state this in your request and an abstract will be provided at no charge.

Otherwise, a fee may be associated with your request. If you are in immediate need of copies regarding your request, please contact a receptionist at 617-243-6236, Monday through Friday, 9:00 am – 4:00 pm (excluding holidays).

Please mail your request to:

Newton-Wellesley Hospital
Health Information Management – Correspondence Section
2014 Washington St.
Newton, MA 02462

Request for Amendment in Medical Record

Please fill in the following form to make a request to amend your medical record:
Request for Amendment in Medical Record (pdf)