Request Medical Records
Trinity Health Of New England Health Information Management Department (formerly, Medical Records) is dedicated to processing your request or inquiry for protected health information in a timely manner. To aid us in fulfilling your request or inquiry please review the listing of frequently asked questions.
Hours of Operation:
Monday through Friday
8:00 a.m. to 4:30 p.m.
Our Locations:
Johnson Memorial Hospital
Health Information Management
201 Chestnut Hill Rd
Stafford Springs, CT 06076
Phone: (860) 714-4646
Fax: (860) 714-8130
Mercy Medical Center
Health Information Management
271 Carew Street
Springfield, MA 01104
Phone: (413) 748-9722
Fax #: (413) 748-9809
Mount Sinai Rehabilitation Center
Health Information Management
490 Blue Hills Avenue
Hartford, CT 06112
Phone: (860) 714-4646
Fax #: (860) 714-8130
Saint Francis Hospital
Health Information Management
114 Woodland Street
Hartford, CT 06105
Phone: (860) 714-4646
Fax #: (860) 714-8130
Saint Mary's Hospital
Health Information Management
56 Franklin Street
Waterbury, CT 06706
Phone: (203) 709-6257
Fax #: (203) 709-3420
Trinity Health Of New England Medical Group - CT
Health Information Management
Phone: (860) 714-4646
Fax #: 1 (833) 213-5417
Trinity Health Of New England Medical Group - MA
Health Information Management
Phone: (413) 796-6712
Fax #: (413) 782-4047
Authorization to Disclosure PHI Form
(English)
Trinity Health Of New England Hospitals
This includes:
Johnson Memorial Hospital
Mercy Medical Center
Mount Sinai Rehabilitation Center
Saint Francis Hospital
Saint Mary's Hospital
Request for Correction - Amendment of Health Information
(Saint Francis Hospital)
Authorization to Disclosure PHI Form
(Espanol/Spanish)
Trinity Health Of New England Hospitals
This includes:
Johnson Memorial Hospital
Mercy Medical Center
Mount Sinai Rehabilitation Center
Saint Francis Hospital
Saint Mary's Hospital
Frequently Asked Questions
To obtain or send copies of your medical records, please download, print, complete and return the Authorization for Release form to the applicable hospital or medical group. A reasonable cost-based fee, to include the cost of labor, supplies and postage may be assessed. See Authorization Form above
Physicians affiliated with Trinity Health of New England or a facility that has Epic as their Electronic Health Record [EHR] have immediate access to your health information through the electronic health record. Please ask your health care provider to review your medical records online. For providers and health care facilities not affiliated with Trinity Health Of New or does not have EPIC as their EHR, you can request that we transfer your medical records. Download, print, and complete the Authorization to Release Health Information form, return the completed authorization form to the applicable hospital or medical group. See Authorization Form above
Complete the authorization form return to:
- Mercy Medical Center - Radiology Department, 271 Carew St., Springfield, MA 01104,
Phone: (413) 748-9200 Fax: 413-748-9393. - Saint Francis Hospital - Radiology Department, 114 Woodland Street, Hartford CT, 06105,
Phone: (860) 714-4850 Fax: (860) 714-8017. - Saint Mary’s Hospital - Health Information Management, 56 Franklin Street, Waterbury, CT 06706,
Phone: (203) 709-6257 Fax: (203) 709-3420
To obtain a copy of your itemized billing statement, please call (860) 714-4952.
If you are requesting records as an HCP agent, the health care proxy must be invoked by a provider and must be made for continuing care purposes.
If you are requesting medical records of a deceased patient, you must submit an authorization along with one of the legal documents obtained through the Probate Court:
- Court appointment as Executor of Estate/ Letter of Authority for Personal Representative
- Court Appointment as Voluntary Administrator/ Attested copy of Voluntary Administration Statement
Federal law permits Trinity Health Of New England to charge a reasonable cost-based fee for copied of medical records (reference 45 CFR § 164.524(c)(4)) Individuals’ Right under HIPAA to Access their Health Information | HHS.gov)
Federal Law provides a health care facility 30 calendar days to process a request for medical records. Trinity Health Of New England will aim to process your request with 10-15 business days, depending on the type of records, dates of service requested, and payment of request.
You will be notified via mail once your request is fulfilled. Please review the invoice for payment to complete your request. Payment may be made by check, credit card or money order.
Trinity Health Of New England has contracted with MRO to process your request for medical records. To check the status of a request, please call (610) 994-7500.
A patient has the right to request an amendment to their health information. Complete the Request for Correction/Amendment Health Information form and return to address located on the form.
A patient has a right to receive an accounting of disclosure of protected health information may by Trinity Health Of New England in the six years prior to the date of your accounting request. Complete the Request for an Accounting of Disclosure of Protected Health Information form and return to address located on the form. Work with Sue to Create, awaiting Pam’s approval
Please allow 2 weeks for processing of the Birth Certificate with the State of Connecticut. Copies of your child’s Birth Certificate may be obtained in person, via mail or online from the Bureau of Vital Statistics. The cost to receive a copy of the Birth Certificate in person/by mail is $20.00 (Long Form); a money order must accompany each request. Online request for a copy of the Birth Certificate is $59.85. Please visit https://www.vitalchek.com for online requests.
Contact Numbers and Addresses:
| Bureau of Vital Statistics Municipal Building Room 103 550 Main Street Hartford, CT 06103 (860) 757-9690 https://www.vitalchek.com |
Saint Francis Hospital and Medical Center |
In Massachusetts, you can obtain a copy of your birth certificate by contacting the City Clerk's office in the city/town that you were born or the City Clerk's office in the city/ town that you resided in at the time of your birth. Please allow 2- 3 weeks for processing of the Birth Certificate with the State of Massachusetts. Copies of your child’s Birth Certificate may be obtained in person at the City Clerk's office, or via mail at the address listed below or online from the Bureau of Vital Statistics. The cost to receive a copy of the Birth Certificate in person/by mail is $20.00 (Long Form); a money order or check payable to "City of Springfield must be included." For Online requests for a copy of the Birth Certificate please visit https://www.vitalchek.com. For more information for obtaining your birth certificate, visit the following websites Vital Records: City of Springfield, MA (springfield-ma.gov) - Order a birth, marriage, or death certificate | Mass.gov
Contact Numbers and Addresses:
| Springfield City Clerk's Office City Hall, Room 123 36 Court Street Springfield, MA 01103 (413) 736-3111 https://www.vitalchek.com |
Mercy Medical Center |
Corrections to the Birth Certificate is corrected by the Health Information Management Department Birth Registrar if, the error was made by the registrar or facility. If the error was not made by the registrar or facility, correction must be completed by Bureau of Vital Statistics.
|
Bureau of Vital Statistics |
Trinity Health Of New England Phone: (860) 714-4415 |
|
Springfield City Clerk's Office |
Mercy Medical Center Email: birthregistry@trinityhealth.org |
Where Do I Send My Medical Record Request Form?
Return the completed form to your applicable hospital’s Release of Information staff via fax, mail or deliver it in person:
- Johnson Memorial Hospital | Saint Francis Hospital | Mt. Sinai Rehabilitation Hospital
- Saint Francis Hospital
Attn: HIM Department
114 Woodland Street
Hartford, CT 06105
(860) 714-8014 (F)
(610) 994-7500 (O)
- Mercy Medical Center
- Mercy Medical Center
Attn: HIM Department
271 Carew Street
Springfield, MA 01102
(413) 748-9809 (F)
(413) 748-9723 (O) - Saint Mary's Hospital
- Saint Mary's Hospital
Attn: HIM Department
56 Franklin Street
Waterbury, CT 06706
(203) 709-3420 (F)
(203) 709-6257 (O) - Trinity Health Of New England Medical Group - Massachusetts*
*Formerly Riverbend Medical Group - 444 Montgomery Street
Chicopee, MA 01020
(413) 782-4047 (F)
(413) 796-6712 (O)
How soon can I expect the medical records request to be completed?
Your request for medical records will be processed within 30 calendar days from receiving the completed request unless we notify you that the request cannot be processed within that time frame, the reason for the delay, and the date by which we will complete action on the request.