Request for Medical Records

How Can I Get My Medical Records
Sent to a Physician or Hospital?

If you need to have your medical records sent to a health care provider, such as a physician or a hospital, for the continuation of your medical care, you do not need to complete any kind of authorization form.

Just have your health care provider call Castle Medical Center’s Health Information Management office at (808) 263‑5153 to request a copy of your records. Your records will then be sent to your health care provider free of charge.

So, When Would I Need an Authorization Form?

You must submit an Authorization to Release Medical Information if you wish to obtain a copy of your medical records for yourself, or if you wish to have them sent to a third party that is not a health care provider, such as an insurance company, a government agency, or an attorney.

In this case, the authorization form must be filled out either by the patient or the patient’s legal representative.

The link at the bottom of this page is to the authorization form in PDF format. With Adobe’s Acrobat Reader, you can fill out the form directly on your computer and print it out. Or, if you prefer, you can just print out the blank form and fill it in by hand.

To complete the authorization form, please:

• Fill in the patient’s identifying information at the top, including the patient’s name, address, phone number, date of birth, and Social Security number.
• On the form, check whether you are going to come to the hospital to pick up the medical records in person or you want the records sent to a third party.
• If you want the records sent to a third party, please include the party’s name and the party’s address or fax number.
• List the dates of the records you want released.
• Specify the date that your authorization will expire. If you leave this date blank, the authorization will remain in effect for one year.
• List the kinds of records you want released. Examples include ER reports, test results from Imaging Services (such as X-ray and MRIs), test results from the Laboratory, operative reports, history and physical reports, and discharge summaries.
• If you wish to release psychiatric, HIV-related, or substance-abuse records, you must initial each one of these items individually on the form. (If you are filling out the form on your computer, this must still be done by hand.)
• If you are coming to Castle to pick up your records, then there is no need for you to sign the form until you get here. But if you are not coming here, please sign and date the form by hand. (You cannot sign the form using your computer.)
• If you are not the patient whose records you are requesting, indicate your relationship to the patient in the field provided.
• Just ignore the field at the bottom of the form labeled “Witness”. We will witness your signature if you come to the hospital to pick up your records.

What Do I Do with the Form?

Even if you are planning to come to Castle to pick up your records, you should fax or mail your form to us, so we can prepare your records in advance.

Normally, it takes 48 hours to copy your records and get them ready for you. Records more than three years old, however, are on microfilm and take considerably longer to prepare. If you have a special need for your records to be prepared on a rush basis, we will do our best to accommodate you.

If you are not coming to the hospital, you should send us, along with your completed and signed form, a photocopy of your photo ID. We may also contact you by phone if we have questions about your request.

Please fax your completed form and, if necessary, a copy of your photo ID to (808) 263‑5385.

Or mail them to:

What Do I Bring to the Hospital?

Before you come to Castle to pick up your records, please call us at (808) 263‑5153 to make sure that they are ready.

The Health Information Management office is located on the first floor of the main hospital building.

In order to pick up your records, you must bring a valid photo ID, such as a drivers license, a state ID, or a passport.

If you are picking up records for a deceased patient, you will also need to fill out an affidavit declaring next of kin status and have it notarized. You can either bring in the completed and notarized affidavit with you, or, if one of our notaries is available at the hospital, we can provide the affadavit and the notarization for you.

What Are the Fees?

There are no fees to send your medical records to a health care provider for the continuation of your medical care when records are sent directly to your provider.

If the records are for you or for a third party that is not a health care provider, then there may be a fee. Please contact the Health Information Management Department for details.

If you have asked to have your records sent to a third party, and there is a fee to be charged, we may phone you concerning payment.

Link to the Form

Please click here to open a copy of the Authorization to Release Medical Information form using Adobe’s Acrobat Reader.

If you do not have a copy of Adobe’s Acrobat Reader, then you can obtain one by clicking on this button: