Request Medical Records

Release of Information

Access to Your Medical Information

You have the right to see your medical record at a time suitable for both you and the staff. Once discharged, you may request and obtain a copy of your record for a reasonable fee. You have the right to request the disclosures we made of medical information about you.

To receive medical records, you must complete and submit the DMC Authorization to Release Medical Information. Download, print and complete the authorization form, DMC Authorization to Release Medical Information and Fees.

Please Note: The second page contains the fees for obtaining medical records.

Complete all areas. Be sure to specify the dates of service and type of information needed (i.e., ER report from specific date visited).

Place the completed authorization form in an envelope and mail - or fax- to the Medical Records department at Children’s Hospital of Michigan.

Children’s Hospital of Michigan
3901 Beaubien Blvd
Detroit, MI 48201
ATTN: Medical Records
Office: (313) 745-8022
Fax: (313) 745-3500
Alternative fax: (313) 993-0763

Records will be sent to you via the US Mail. Medical Emergencies will be faxed directly to a physician or medical facility. Our average turnaround time for processing requests for records that are on-site is 5-7 business days, off-site records 2-4 weeks.

Please Note: Address the envelope Attn: Medical Records

If you are requesting records sent to you directly and not your physician you will receive a bill. If you have any questions, do not hesitate to call us.

Confidentiality of Care

Your medical record will be treated as confidential by the hospital staff. No one outside the hospital, except your referring physician, may be given a copy of your record without your written permission. Exceptions are as required by law, transfer of care or third party payor/insurance contract.

You have the right to have a family member and your own physician notified of your admission to the hospital.

Obtaining Copies of Medical Records

Records can be released to anyone that the patient authorizes (in writing) to receive such information. A valid authorization MUST contain the following information or the request will be returned:

1. Patient's full name and date of birth (list any other names the patient may have had).
2. Specific information being requested (e.g. type of report/information and dates of service, etc.)
3. Purpose for which the information may be disclosed.
4. To whom the information is to be sent (name and address)
5. Specify authorization’s expiration date if desired (see ROI form)
6. The patient's signature or a patient's legal representative’s signature. Authorizations signed by a representative must contain a copy of the guardianship papers or power of attorney.
7. Date of the signature

Sensitive Information

Certain information requires a special authorization covering sensitive information. This includes psychiatric, drug and/or alcohol abuse, HIV/AIDS, and sexual abuse information. Authorizations for sensitive information must specifically refer to the information that is to be released.