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You can also request copies of your medical records for your own personal use. In order to respect your right to the privacy and confidentiality of the information contained in our medical records, we ask that you complete the Authorization to Release Medical Records if you are requesting a copy of your medical record for any care provided by Hartford HealthCare Medical Group. We are inviting entrepreneurs from across the world to evaluate proposed new technologies and products with our clinical experts. <> medical records and release of information. 4 0 obj Requests for records should be made by using the Authorization for Release of Information forms below. The Hospital of Central Connecticut (THOCC) is a 414-bed, 32-bassinet, acute-care community teaching hospital with campuses in New Britain and Southington. Donations to Hartford HealthCare are managed by the Hartford Hospital Department of Philanthropy, a Connecticut tax-exempt organization under section 501(c)(3) of the IRS code (E.I.N. You must be 18 years of age or the parent or legal guardian of a minor patient or have some other legal authority to request a medical record. If you pre­fer to com­plete a paper autho­riza­tion form, please down­load and print the Autho­riza­tion for Release of Health Infor­ma­tion Form. If you cannot download the form, you can send an email or written request for your medical records indicating: patient name, date of birth, type of information you are requesting, information that cannot be disclosed, and/or who may receive this information. To obtain your medical records you must submit a completed Release of Information form. To request a copy of your medical record, please print out and complete the form below. Form Revised: 1/2018 201177375_2 LAW AUTHORIZATION TO RELEASE INFORMATION LAST NAME MIDDLE NAME FIRST NAME ALL FORMER NAMES (Maiden, Alias, etc.) Box 400 Wallingford, CT 06492. >>, Hartford HealthCare ha ampliado su capacidad de pruebas del COVID-19 y ubicaciones. %���� One State Street, Suite 19, Hartford, CT 06103  •  Contact Us. Medical Records Alert: We've Enhanced Safety Measures - Don't Delay Care: COVID-19 >> Alert: We've Enhanced Safety Measures - Don't Delay Care: COVID-19 Español >> We can provide or release copies of medical records at the written request of patients or their authorized legal representatives. Medical records for services provided at Manchester Memorial Hospital, Rockville General Hospital, ECHN Medical Group, Woodlake at Tolland (WAT) or Visiting Nurse & Health Services of Connecticut (VNHSC) facilities can be provided at the written request of patients or their authorized legal representative, such as a Power of Attorney (POA) or healthcare representative. Hartford Hospital can provide or release copies of medical records at the written request of patients or their authorized legal representatives. The Medical Records form is available online ( below ) or can be obtained by visiting the Health Information Management Department during normal business hours. The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin. %PDF-1.4 Authorization for Release of Information to a third-Party (a Non-UCLA Provider, Insurance Company, Attorney, etc.). Mail or drop off the form at: Health Information Management – Release of Information N17 W24100 Riverwood Dr., Suite 200 Waukesha, WI 53188. Hartford HealthCare Offices. Contact the Medical Records Department. Request medical records from Froedtert Hospital (Milwaukee, Wis.), ... Hartford, WI 53027 Ph: 262-836-2510 Fax: 262-836-8490. 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