Medical Record Information It is the obligation of the hospital to protect the confidentiality of our patients’ medical records. Any information contained in the medical record is confidential and protected by federal and state law. Therefore, patient information will only be released upon receipt of appropriate patient authorization, valid subpoena or court order. Patients must complete the Authorization for Release of Protected Health Information form in order to obtain a copy of their medical records. For patients who are younger than 18, parents, next of kin or legally appointed guardians must complete the form in order to obtain a copy of medical records. When a minor has received treatment for sexually transmitted disease, birth control, drug/alcohol abuse, HIV or mental illness, the records will only be released upon the minor’s authorization. A qualified person or personal representative may obtain the records of a deceased patient upon receipt of a notarized, written request, or a completed Authorization for Release of Protected Health Information form and letter of testamentary or a letter of administration from a Surrogates Court. Questions regarding the release of deceased patient records in the absence of these documents should be referred to the manager of the Health Information Management department. How to Submit Requests for Medical Records Fax the completed Authorization for Release of Protected Health Information form to 860.837.5785 or send it by mail to: Connecticut Children’s Medical Center Connecticut Children’s Specialty Group Health Information Management Department Attn: Release of Information 10 Columbus Boulevard, 4th Floor Hartford, CT 06106 NOTE: Please complete all sections of the release form. Incomplete forms will not be processed. Contact Us All inquiries regarding requests for access or release of protected health information should be directed to the Health Information Management department by calling 860.837.5780.